Mechanistic Reasoning and Science Based Physio

September 2, 2017 Kenny Venere

The idea of science based physiotherapy (adapted from the popular science based medicine) is a response to the notion that evidence based physiotherapy places too great an emphasis on comparative clinical studies at the expense of basic science. This is to say that evidence based physiotherapy undervalues, or even ignores aspects such as mechanisms, mechanistic reasoning and biological plausibility. This call for a greater emphasis on improving our mechanistic reasoning and our understanding of how and why we achieve the outcomes that we do is important. Sound mechanistic reasoning can improve the manner in which we research and deliver interventions while helping rule out more far-fetched ideas prior to dedicating limited scientific resources to them. This is because it encourages us to ask the question “are we confident that this treatment aligns with current knowledge of biology, physiology and physics?” As with all things, of course, it is important to recognize the limitations of our mechanistic reasoning as means of justifying our treatments.

Expectations Versus Reality

December 17, 2016 Kenny Venere

If a patient comes into a clinic, naive to the incredible benefits of Therapeutic Cabbage Rubbing and a physical therapist proceeds to sell them on how truly remarkable cabbage is, informing them of the unique resonance the cabbage creates when rubbed on skin, the science-y neurophysiological effects and stories of the success other people have had with the treatment from a position of assumed knowledge with obvious charisma — That patient might actually leave the clinic feeling a little better and be more likely to seek out therapeutic cabbage rubbing in the future.

Now say they walk into your clinic and as a well informed physical therapist, you know that therapeutic cabbage rubbing has no basis in our current understanding of physiology and lacks clinical evidence to support its efficacy and effectiveness, but this patient REALLY expects that the cabbage will help them out — does this expectation all of a sudden make Therapeutic Cabbage Rubbing a well reasoned treatment option?

No.

Interventions Are Not Identities

November 12, 2016 Kenny Venere

Physical therapy is a profession that struggles with identity. Not only do patients have a limited understanding of what exactly a physical therapist does, but physical therapists themselves have difficulty defining what makes a physical therapist. This identity crisis is a multifaceted issue, but one of primary contributors is the idea of defining the physical therapy profession with particular interventions.

Actually, Research Does Apply To Your Patients

August 21, 2016 Kenny Venere

One of the arguments I see used as a way of quickly disregarding published evidence, particularly those with negative results, is the idea of internal validity coming at the expense of external validity — essentially that the trial is “too controlled”, not representative of the patients actually seen in the clinic and does not account for certain variables. This is absolutely true, there are plenty of issues with generalizability from research into practice. However, I am not convinced that this general argument is compelling enough to disregard the results of trials studying particular treatments.

Patient Centeredness and Evidence Based Practice

August 13, 2016 Kenny Venere

Patients should unambiguously be at the center of our care. This is not up for debate and hopefully not a controversial idea. However, I continue to observe the manufacturing of a false dichotomy in which embracing evidence based practice and science somehow has to come at the expense of patient centeredness. Ensuring we are using the most effective and plausible interventions is fundamentally patient centered, because it is the patients who ultimately benefit from this. Having a strong foundation in science and research allows us to achieve this.