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How strong is the current podiatric evidence base?

Discussion in 'General Issues and Discussion Forum' started by shellyvortex, Oct 7, 2008.

  1. shellyvortex

    shellyvortex Member

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    Hello all,

    Can anyone help? Given the current push towards clinical evidence & evidence based practice I wonder whether professions are 'rated' according to how strong it's specific evidence base is? As systematic reviews occupy the No.1 spot for validity- I have searched for all these reviews in relation to podiatry, and come up with 14 so far. Does this sound accurate- or am I completely missing some elusive database somewhere??:confused:

    please correct me!
  2. Johnpod

    Johnpod Active Member

    Hi shellyvortex,

    I am not aware of any 'rating' applied to professions based upon the strength of their specific database.

    This may be fortunate for Podiatry. In my opinion the directive to treat from the database is somewhat misguided since the podiatry-related database is somewhat thin, to say the least. For instance, a search for 'corns' on Pubmed returns much more information on feeding chickens than it does on the subject of hyperkeratotic lesions!

    Perhaps what was intended was that we should treat by the application of science - rather than belief? With this I am in full favour.

    Three particular aspects of the database cause me concern:

    1. The academic language of many papers is not conducive to them being readable or understandable - the fact you want may be there, but can you find it?

    2. We can do the same thing in identical fashion to two matched patients and get two different results - does the database necessarily help? Is it applicable? Does it predict the outcome?

    3. Much of the database is only available to those working outside large institutions on payment of a fee per paper. Many of us in private practice do not hold Athens accounts or have NHS access. This is largely an ethical question: should the data only be available on payment of a fee - given that we are required to consult it so closely and apply its teachings? Should library based knowledge cost to acquire? We all know registered colleagues who couldn't be bothered to research the evidence database, even that which is available. Any obstacle put in their way makes effort even less likely.

    Point three could be met if every professional (in the UK- HPC registrant) was given an access licence to the data as part of their registration, rather as a university sets up an Athens account for its students. This would then become a real benefit of registration and elevate the professional above the tradesman.

    As it stands, the resourceful non-registrant has effectively free access to the entire Internet, much of it in very readable language.

    One final thought: is best practice always always the same as best treatment?
  3. Excellant post John, as always.

    I would add the following.

    Its worth, when considering EBM to also consider the role of deductive as opposed to inductive evidence. Both are important and both are valid.

    Dave Smith once said, and i made him exactly right, that he is increasingly of the view that solid deductive evidence can be more valid than shaky inductive evidence (correct me if i'm wrong Dave)

  4. Johnpod

    Johnpod Active Member

    Cheers Robert,

    I think experience combined with the power of close observation is almost as important as the evidence base?

    This is perhaps a wee bit off-thread, but the ability to imagine if something is sore (and thus put on a protective dressing before being asked) is also an important ability in successful practice. How to do these things is not on the evidence base.
  5. I agree. These "soft skills" are hard to teach and I find tend to come with experience (although I have known a few who had them instinctivly).

    Not evidence based, but absolutly vital in biomechanics as well as blade on podiatry.

    The amount of SCf I apply post cryo increased sharply after I had it myself!

    So far as experience and observation, that is vital certainly. However I do beleive it must be tempered with hard inductive evidence. Empiricism is useful but also highly vulnerable to error!

    Kind regards
  6. Craig Payne

    Craig Payne Moderator

    Are you asking for Podiatry compared to other professions? or are you asking the strength for the interventions that we often use (and are commonly used by other professions)?
    Can you post the bibiliography?
  7. a.mcmillan

    a.mcmillan Guest

    Hi All,

    I hope this isn't too out of context, but I have recently come-across a paper from the field of psychology that may be useful on this thread. It focusses on solutions to the increasing problem of division between clinical research and clinical practice.

    I have often been impressed by the drive in clinical psychology for evidence-based practice, and find their methods very adaptable ....

    I have pasted below the abstract, and a couple of paragraphs from the full-text. Also attached in PDF:

    Hope this is of some relevance :eek: !



    Attached Files:

  8. Admin2

    Admin2 Administrator Staff Member

  9. shellyvortex

    shellyvortex Member

    Hi Craig,

    I've found 17 systematic reviews so far that relate specifically to podiatry(posted below). And that really was my question, how many exist that are specifically to do with pod practice? Systematic reviews can be of more help to clinicians when embarking upon particular management plans, and are considered the best form of evidence in the hierarchy of evidence. There is a push, certainly in the UK, for every treatment to have an evidence base, sadly there seems no balance to offset this against clinical experience and anecdotal evidence- but there we have it. we must move with the trends!

    systematic reviews in relation to pod:

    Silver based wound dressings and topical agents for treating diabetic foot ulcers

    Patient education for preventing diabetic foot ulceration

    Debridement of diabetic foot ulcers

    Pressure relieving interventions for preventing and treating diabetic foot ulcers

    Oral treatments for fungal infections of the skin of the foot

    Topical treatments for fungal infections of the skin and nails of the foot

    Interventions for treating hallux valgus (abductovalgus) and bunions

    Interventions for preventing and treating stress fractures and stress reactions of bone of the lower limbs in young adults

    Interventions for treating plantar heel pain

    Topical treatments for cutaneous warts

    Surgical treatments for ingrowing toenails

    Interventions for the treatment of Morton's neuroma

    Braces and orthoses for treating osteoarthritis of the knee

    Orthotic devices for treating patellofemoral pain syndrome

    Hawke FE, Burns J, Radford JA, du Toit V. Custom-made foot orthoses for the treatment of foot pain. (Protocol) Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006801. DOI: 10.1002/14651858.CD006801.

    Interventions for the prevention and treatment of pes cavus.
    Burns J, Landorf KB, Ryan MM, Crosbie J, Ouvrier RA.
    Cochrane Database Syst Rev. 2007 Oct 17;(4):CD006154.

    Insoles for prevention and treatment of back pain.
    Sahar T, Cohen MJ, Ne'eman V, Kandel L, Odebiyi DO, Lev I, Brezis M, Lahad A.
    Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005275

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