(That study was covered
here)
Firstly,
my challenge was about the list of articles on the site I linked above and they do not have that one there, so you loose on that one
:D
Secondly, it was a small sample size and there was no control group, so we have no way of knowing if the results were not due to the placebo or Hawthorne effects. It was just an uncontrolled case series which is only one step up the hierarchy of evidence ladder from an anecdote, so you loose on that one as well! :D
HOWEVER, having said..... that I am currently writing an
essay for a book chapter on where does knowledge for clinical practice come from and what to do in the absence of evidence and at what stage should clinicians change clinical practice ...... I am using that study as an example.
One of the principles I use is what I mentioned in this thread on
Dennis's foot typing about what to do in the absence of evidence:
1) Theoretical coherence
2) Biological plausibility
3) Consistent with the available evidence
So in that uncontrolled case series on anterior compartment syndrome, despite its limitations, the results were dramatic (all subjects were spared surgery) and there is a theoretical coherence and plausibility and it is consistent with the available evidence ...... when forefoot striking it is theoretical and plausible that the anterior tibial muscle does not work as hard as when heel striking ... which is consistent with the evidence......
so it makes sense it would help anterior compartment syndrome.
So do you change practice based on that study?
At one end of the spectrum we have the anecdotes from nutters who think everyone should do what they do as it worked for them, and at the other end of the spectrum you have the EBM aficionados who sit behind a computer and never have to make a clinical decision that you should not change practice until there are enough RCT's to collate into a meta analysis ... and then you change practice.
So do you change practice based on that study? I think we should based on the biological plausibility, theoretical coherence and consistent with the available evidence, despite the weakness of the study. I think we should be transitioning those with anterior compartment syndrome to forefoot striking ... I
will give you that one
:D
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