Perhaps the greatest mind in the entire history of the world - well in my estimation anyway - once argued that it is the the things that are the most obvious and seemingly benign that we should focus all of our critical attention upon, because these are the things that are doing the best job of concealing the immense power that allows them to become so seemingly obvious in the first place. (If you hadn't realise already, that man is Michel Foucault). Well of all the seemingly obvious, taken-for-granted and largely unchallenged ideas currently pervading physiotherapy, evidence based practice must surely be one of the most obvious ideas needing critical scrutiny. Fortunately, a few … [Read more...] about Is it time to end the tyranny of evidence based practice?
A very interesting thing has been happening with the CPN blog in recent weeks. After publishing two relatively controversial blogposts - one on Six useless treatments and the other titled There are no new treatments in physiotherapy, we saw a big spike in members and enquiries through our email service. The post There are no new treatments in physiotherapy has been accessed more than 15,000 times on Facebook, and Six useless treatments nearly 13,000 times. These might not be particularly big numbers for Justin Bieber, but they are for most groups in physiotherapy. What is it about these posts that made them so popular? Based on some of the emails we received after they went … [Read more...] about Desperately seeking evidence
The Australian Physiotherapy Association (APA) recently pronounced that six interventions commonly used by physiotherapists are useless and were no longer being supported (link). As part of the Choosing Wisely initiative, the APA has decided that requesting imaging for certain instances of non-specific low back pain, cervical pain, and acute ankle trauma; plus the routine use incentive spirometry after upper abdominal and cardiac surgery, electrotherapy in cases of lower back pain, and manual therapy for patients with frozen shoulder, are all now discouraged. There are some interesting aspects to this decision that warrant some more thought. Firstly, there is the … [Read more...] about Six useless treatments
This post comes from CPN member Carley King. Carley is a physiotherapist who has developed an interest in evidence based medicine during her Masters in Clinical Research. Here Carley reports on the recent debate on the value of Evidence based medicine at the CSP Congress. Spoiler alert: I’m not sure that evidence-based medicine (EBM) as we understand it at the moment is fit for purpose. That’s my bias out in the open! But on hearing this opening line, I couldn't help but allow a small part of me to wonder if it was ridiculous to even consider an alternative...a very clever debating ploy there! As the debate progressed, it became clear to me that there were some key issues … [Read more...] about Evidence based medicine: why are we even debating it?
A quick question, to which I'm sure there is probably an easy answer: I've heard it said many times in recent years that physiotherapists in private practice should be confident enough to charge what they think they are worth, and that people only truly value something if they have to pay for it. If which case, isn't this just another form of placebo where people gain additional benefit because they've paid more? And isn't that at odds with the idea of evidence-informed practice? … [Read more...] about Is there such a thing as a payment placebo?
I'm doing a public lecture next week on physical therapies in the 19th century (you will be able to see a live feed or delayed broadcast of it here if you're interested in hearing about it), and the whole project has been fascinating. One thing that occurred to me doing the preparation for the talk was how many images there are of people sitting in mud baths and hot springs. There was never any real proof that these things did anything other than warm you up, but there was a lot of anecdotal evidence that they were used to treat all sorts of diseases, from syphilis to sciatica, asthma to psoriasis. Suffice to say, in 19th century New Zealand, hot pools were a natural phenomenon, … [Read more...] about Physiotherapy and the zone of play
Some of the discussion following the release of the CSP's recent video A new vision for physiotherapy prompted some interesting thoughts about the constant tension we face if we are to anticipate the future for our profession (link). A couple of issues surfaced from the blogpost and the comments that followed that prompted me to think about the link between physiotherapy, politics and evidence-based practice: Firstly, in defence of the CSP, it cannot be easy being a professional body these days. Social media has opened up great opportunities for communication and sharing of ideas, but it has also made a critic of everyone. This is perhaps one of the most important and challenging … [Read more...] about Physiotherapy, politics and evidence