From day one on The Arena, I have stated that I am primarily a physician and clinician and not a research scientist or Ph.D.
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Frankly, I find the biased skew for a call to produce EBM that has risen to importance in biomechanics recently, may be calling for the elimination or vestigialization of the physician and practitioner, the expert and the textbook.
This fact is wearing when applied to biomechanics when weighted upon the fact that so little true, valid, high level evidecne actually exists.
This very facts calls upon expert opinion to be of great import as we call it {"low level").
IMHO,
1. Waiting for the evidence to exist before treating a patient in front of a practitioner seems very ludicous from the patient perspective.
2. The opinions of too many biomechanicsts vascilate from totally evidence based all the way to virtually eliminating evidence as a criteria when somewhere in the middle IMHO should be the current position of us all.
This means that the very expert nature of our opinions, clinical experience, anecdotal evidence and textbook and theoretical publishing vascilates from being extremely important to worthless from post to post since none of us has evidence to back up our biomechanical protocols.
If Shavelson, Kirby, Glaser and Payne all have mostly low level, scant additions to the literature to back up our expert opinions and if evidence reigns supreme, why should either the student or the guru listen to anything any of us has to say?
Here is a quote attributable to one of the following:
Shavelson, Kirby, Glaser, Payne.
EBM Question 1 is a two parter.
Which of these biomechanical experts penned it?
and
What do you think of its import and applicability on a Biomechanics EBP or in fact in Modern Biomechanics Doctrines?
Dennis
"While I am all for research evidence to support what I do for my patients on a daily basis, I am not supportive of restricting logical and mechanically based treatments that are clinically effective but lacking research evidence, all for the cause of evidence based medicine (EBM). I really think restricting treatments to only those that have research behind them is not always in the patient's best interests.
I believe that it is only the very near-sighted clinician or the insurance company or the government health plan that is interested in limiting the treatment of individuals with musculoskeletal pain to those treatments that have research evidence behind them. One of the reasons evidence-based research is so popular now is probably that this is one way for insurers and government health to have what they consider a valid excuse to deny effective (what they call experimental ) treatments so that they can save money on health care for the members they are supposedly caring for. I really hope that no one actually believes that these insurers or government agencies care that their decisions to restrict care to only "evidence based treatments" is based solely on wanting to help patients?? Come on now, let's not be so naive!
For example, since there is no research evidence that the medial heel skive technique is effective at treating patients with posterior tibial dysfunction, then this "experimental" technique, that is now 15 years old, would not have been used by the "evidence based only clinician". I think that the hundreds of patients I have cured from PT tendon pain with this technique are very happy that I didn't wait years for definitive research to finally claim that the medial heel skive orthoses is effective to treat patients with this pathology. I am sure that these patients are very happy that I have used mechanical intuition and modelling techniques to come up with mechanical therapies for many foot and lower extremity pathologies that have not been studied or even had clinical names applied to them. Do you really think that patients care if their treatment is "evidence based" as long as it gets them better and relieves their pain?!!
I didn't get into this profession to practice evidence based medicine. I got into this profession to make patients better and whatever it takes to make them better is exactly what I will give to my patients, regardless of whether it has research evidence to back it up, or not. I will probably be retired or dead before the research catches up to the many techniques that I use on a daily basis to heal patients' foot and lower extremity injuries. I am not willing to allow my patients to suffer needlessly waiting for researchers to catch up with the logical mechanical thought processes that go into the treatment decisions that I make on a daily basis. I really could care less if someone thinks that I am an "evidence based clinician". However, I do care greatly that patients think that I am an "effective clinician".
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