Tel: 01 283 4303A Physiotherapist could have read all the books, know the research inside out and believe they are practicing evidence based medicine. But, they may not be very good at actually resolving their client’s complicated condition. Here's why;
The term ‘evidence based medicine’ is one which is used a lot within medicine and the practice of Chartered Physiotherapy these days. It is considered the best practice approach and one we all strive towards.
But what does it actually mean?
Many Physiotherapists would tell you that it is all about looking at what the scientific research evidence is telling us works best for a certain type of problem in accordance with randomised controlled trial findings - and then applying the information in practice when treating clients.
This is however not what Sackett et al had in mind when defining evidence based medicine.
A clearer definition
The more accurate definition according to Sackett et al (1996) does of course involve combining research evidence with a Physiotherapists clinical experience and expertise but must also consider the clients expectations, values and beliefs when determining what the best course of treatment might be for the individual. True evidence based medicine is a more integrated approach which places a lot of emphasis on the skills and years of experience of the individual Physiotherapist, both clinical skills and ability to understand their patient.
The benefits of this integrated approach reveals itself time and time again at our weekly team ‘complex case discussion’ meetings. We continually find ourselves trying to find the right balance between; knowing what the books tell us to do, our collective experiences in such cases and the precise needs and expectations of the client. We share proven techniques and find ourselves reviewing latest literature together for further understanding.
Client example
We had a recent discussion relating to a client with a complex pain problem related to overactivity of the back muscles. Most people with low back pain are often told that their muscles, especially the deeper ‘core’ muscles are not working hard enough. Years of working with clients, supported by new research evidence, tells us that this is not always the case and that having these muscles working too hard can actually be the very cause of pain.
An open discussion, demonstration of appropriate exercises and evidence review involving four experienced clinicians set the client on the right track early on in the course of treatment. She is now receiving treatment based on relaxing or ‘winding down’ the overactive muscles which includes gentle spinal mobilisation, dry needling and relaxation techniques. In addition she is attending Pilates at the clinic with an emphasis on ease and fluidity of movement rather than rigidly trying to activate certain muscles.
Early results have been very good and we feel confident that she will continue to improve during the course of treatment and beyond with good self management skills.
By Simon Coghlan MSc, BSc Hons, DipMedAc, MISCP
Simon holds a Master of Science Degree in Physiotherapy and is a member of the Irish Society of Chartered Physiotherapists. A post graduate Diploma in Medical Acupuncture entitles him to accredited membership of the British Medical Acupuncture Society. Simon specialises in the integration of medical acupuncture techniques with manual therapy and therapeutic exercise for the treatment of musculo-skeletal pain and dysfunction.
