Is Physiotherapy a Science?

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Rigil Kent (May 01, 2010, 11:27:31 AM):
Benguela, if we squarely disregard anecdotal accounts as evidence for the effectiveness of physiotherapy, then I forsee a grave problem in evaluating its effectiveness at all. And that includes evidence like:
Quote
The orthopedic surgeon said I wasted my money, it would have healed itself anyway.


To evaluate, we must measure. So, first of all, how do you propose we measure the effectiveness of physiotherapy, if not subjectively?

Stevemuso's slipped disc is easy - its either in place or it ain't. But how about muscular pain relief? How do you measure that, if not by verbal account?

Mintaka
Peter Grant (May 01, 2010, 11:51:25 AM):
To evaluate, we must measure. So, first of all, how do you propose we measure the effectiveness of physiotherapy, if not subjectively?

Stevemuso's slipped disc is easy - its either in place or it ain't. But how about muscular pain relief? How do you measure that, if not by verbal account?

Mintaka


Whether or not a treatment provides pain relief is somewhat subjective, but whether or not the associated risks are acceptable to the profession should not be. I click my own back and it does provide pain relief, but the long term effects probably aren't good.
benguela (May 01, 2010, 12:05:24 PM):
So, first of all, how do you propose we measure the effectiveness of physiotherapy, if not subjectively?
But how about muscular pain relief? How do you measure that, if not by verbal account?

Very good questions, thanks Mintaka. Your questions have led me to investigate this and I learnt that in medicine a case study is anecdotal evidence based on a large sample of anecdotes, the study is then peer reviewed. Case studies are not the best form of evidence but it's the best science can do in many cases ;). Therefor I retract my first statement and now assert that the anecdotal evidence I presented is better than the anecdotal evidence presented on this topic from individual skeptics. It would require a larger sample of anecdotes, from skeptics, to be considered as evidence.







GCoe (July 01, 2010, 12:24:15 PM):
Sorry for not replying for a while. I lost this site for a bit

I agree that it would be good to physiotherapy become more standardised. One would hope that you should receive the best possible treatment based on the best possible evidence. Physiotherapy is moving in this direction although unfortunately not all in unison and not all at the rate as many of us would like.

It should be pointed out that physiotherapy is a very broad discipline and the aches and pains, musculoskeletal injury type of physiotherapy is just one branch of practice. For example I practice in neurological physiotherapy so that is more helping people with problems such as stroke, MS or Parkinson's Disease with movement and function. another very important branch is cardiopulmonary physiotherapy and there are many smaller specialities such as those working in womens health, occupational rehabilitation and prevention and so on.So it gets quite hard to draw generalisations.

However when consulting a physio here are some suggestions:

While there are lots of specific evidence based treatments, on the whole active exercise and guiding people towards the resumption or increase in physical activity are strategies that have been found to be effective in a very wide variety of conditions and injuries. In contrast more passive modalities such as electrotherapy, applications of head and cold, massage, manual therapy often turn out to be disappointing. Please note these are generalisations and the inclusion of passive modalities as part of a treatment plan may have their place some of the time. However they have been greatly overrated and overused. A therapist that concentrates heavily on passive modalities is probably not going to deliver the goods. One reason why these passive modalities have been heavily relied on is that they do make great placebos!

Ask the therapist to provide evidence for the treatment they are recommending. The therapist should be able to provide you with well conducted systematic reviews of clinical trials or at least some well conducted clinical trials of their treatment to justify their treatment. This is not always the case, particularity in less common injuries or conditions so to be fair the physiotherapist can't always oblige. However this is a good practice for patients to ask: it drives therapists to be more accountable in their practice. If the therapist scoffs at doing this by denigrating evidence-based practice, resorts to anecdotes or to fanciful theories then shop elsewhere.

If you want to check out the best evidence for a particular treatment for a particular problem there are a number of resources but one of the best is PEDro's patient-friendly database:

http://search.pedro.org.au/physiotherapy_choices/findrecords.php?-type=new_search

PEDro is the Physiotherapy-specific evidence-based database. It is limited to research-based treatments but is quite extensive.

Therapists should be aware not just of a specific problem such as pain, weakness or stiffness, but should be able to relate this to your daily activity, how the problem is affecting the participation in life areas that matter to you and how the problem is affecting the quality of your life. Treatment goals should take into account these broader issues. In the end physiotherapy is about helping you get more out of life.
Brian (July 01, 2010, 16:44:08 PM):
again speaking as a patient I've had several serious procedures including fusing three vertebrae in my neck (totally painless), a total knee replacement TKR(frecking painful) etc and each time Physio was required. The TKR took 8 months to reach approximately the same degree of flex in my knee as a normal knee and without physio would never have happened. It was painful but critical. A science...no I believe that's an incorrect question...each patient is different and while the science lies in understanding the human body, the treatment (whether it be systematicly, correctly or idiosyncraticly indicated) may differ. Is Physio useful? Yes in most instances it is but it also has its limitations.

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