Modern medicine and physical therapy should be predicated on the delivery of high-quality care based off of data from robust clinical trials. However, clinicians and patients are often deceived by the selective publication and reporting of trial data, known as publication bias. The Cochrane Handbook defines publication bias as “The publication or non-publication of research findings, depending on the nature and direction of the results” and is “one of the worst threats to the validity of scientific research.” This phenomenon was first described by Thomas Sterling in 1959 and nearly 60 years later, the problem of publication bias is still embarrassingly common across biomedical and social sciences.Read More
Evidence-based zealots, robotic clinicians, animated youtube videos of physical therapists turning patients away due to lack of support from randomized controlled trials — There are numerous examples, said in different ways, but ultimately the message is the same. Physical therapists, in hopes of being evidence-based, become handcuffed by research and in doing so lose their ability to empathize and stymy their flexibility in clinical reasoning.Read More
She sat there, leaning back in her recliner, listing off the numerous side effects she had been enduring since resuming her experimental chemotherapy agent. Nausea, fatigue, headache, poor appetite, wild swings in blood pressure, dizziness.
“It’s a really hard drug for me. It takes its toll. I stand up to go do things around the house and just getting up can wipe me out. Then, I realize ‘maybe I’m not as young as I want to be!’” she explains.Read More
Effective healthcare can be thought of as delivering the most beneficial treatment(s) at the minimum dosage required to produce a positive outcome that outweighs associated side effects and cost. Unfortunately, healthcare is too often wrought with overdiagnosis, overtreatment and exorbitant costs while producing a less than desirable outcome. Pain, in particular, is an overwhelming burden on both individuals and society at large with an estimated economic cost of 560-635 billion dollars a year. This is in part due to an abundance of diagnostic approaches that fail to identify meaningful pathology, leading to numerous treatments that fall short of delivering a meaningful outcome. Unfortunately, many of the treatments designed to address people’s pain have been well studied and found to lack a meaningful benefit, but nevertheless, these interventions continue to be delivered, often by passionate purveyors eager to fill a desperate need.
In the face of evidence demonstrating that many of the treatments offered to patients fail to justify their continued use when adequately controlled and studied, why do ineffective treatments persist in clinical practice? Many of the contributing issues are by no means unique to physical therapy and more broadly are inherent to human nature and reasoning. Nevertheless, I am a physical therapist and as such these issues will be viewed through a physical therapy lens.Read More
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.Read More