If you have ever visited my clinic, or attended one of my Workshops, you will have heard me talk of “what the evidence says”, and “evidence based practices” until the words become almost meaningless, and so I thought I would take a few minutes to describe what exactly I mean by that, and why I feel it is such an important part of what I do.
I came across a clinic recently offering a ‘Scientific Knowledge and Experience’ based approach, swiftly followed by advertisements of treatments with evidence that is at best inconsistent, and at worst non-existent. I saw another clinic advertising;
….which – and I cant sugar-coat this I’m afraid – is complete drivel.
For a treatment to be offered, I fully believe that the therapist offering said treatment must be able to stipulate exactly why this treatment will move your rehabilitation forwards. There are of course limitations to most treatment modalities, but to offer the service, the research must show benefit to the client, or else we get into the realms of an ethical debate; can a service be offered if the research does not support its use?
It would be incredibly easy to do so, as often a therapist is seen as the authority in the room, and the client can feel pained, desperate and even vulnerable, so will take whatever advice or treatment is offered.
I believe good therapists choose the harder route; good therapists refuse to stick to the oft repeated party lines of the unchallenged past – such as bending over is bad for your back, when “…research suggests that back pain is twice as common in the developed world compared to less developed nations..” ….(Ref 1)
….or the new in vogue conditions…
The honest therapist has to work harder, because they can’t rely on age old myths of poor posture being to blame for everything; or a “weak” core causing pain; or advising stretching to everybody, for every ailment.
An honest therapist makes their own job harder, so that you can improve quicker.
A less honest therapist can hide behind regression to the mean because – hey, sometimes, things get better no matter what you do, so lets utilise placebo and discuss a 10 week treatment plan…
Cupping (Ref 2) and acupuncture (Ref 3, 4, 5, 6) are great examples of treatment modalities that are growing in availability at roughly the same rate as the indifferent (or ‘potential benefit’) research coming out regarding their efficacy. They are obviously popular, but if the (paying) public were offered the treatment with the research, would they still be, knowing that the effect is potentially linked? I genuinely don’t know.
Foam Rolling and Kinesiology tape are a little more interesting as the research goes both ways, but, again, is it ok to recommend a treatment with such divisive results?
There is a battle between giving people what they want – as there is, again, obviously a demand for such treatments – and giving treatments which peer-reviewed scientific study suggests will move them forward. Of course the research is more important to me, on my side of the couch, but should we not, as therapists, be the ones communicating the evidence to the other side of the couch, to allow collaborative decision making?
We therapists and health professionals spend fortunes on courses learning new skills, but what is the reasoning behind theses skills? Just because the course was expensive, we should be able to acknowledge that not all is as it seems, regardless of how uncomfortable it is to do so, should we not?
Even if you don’t always want to know why, or even how a treatment modality works, surely you would want to know if it works?
I would be very interested to hear your thoughts; feel free to email Dan@DC-InjuryClinic.co.uk.
REFERENCES
- The epidemiology of Lower Back Pain in the rest of the world, Violonn E, 1997
- http://www.imr-journal.com/article/S2213-4220(15)00359-5/abstract
- https://www.painscience.com/biblio/acupuncture-treatment-for-pain-review.html
- https://www.painscience.com/biblio/best-acupuncture-evidence-shows-only-trivial-effects-on-pain.html
- http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005319/abstract;jsessionid=BEF08C0098B706BF5374B983683DF8C4.d04t02
- https://www.painscience.com/bibliography.php?ee16