In recent years, Physical Therapy research has emerged that compares surgical interventions to placebo surgeries. For certain conditions, there is now fairly substantial evidence that surgical intervention is not always necessary despite what is considered standard societal practice. The most recent example of this is a December 2013 article written by Sihvonen et al, that investigated arthroscopic surgical menisectomy compared with placebo surgery for individuals with degenerative meniscal tears. The results were pretty interesting! In a recent post by Leonard van Gelder at Dynamic Principles, he discusses the reasons behind why this appears to continually be happening & gives several good examples of when conservative management is either more successful or equally successful as surgery.
Questions you need to ask yourself:
-If patients have similar results in surgery vs. placebo surgery, what is at fault in the patient? The mechanical system cannot solely be the answer. The answer lies in the patient's belief system regarding tissue healing and surgery.
-How should this change the type of education you give a patient regarding certain conditions?
-How do you manage a patient that strongly believes surgery is the answer (after a disc herniation for example) despite knowing that surgery is not always the best course of action.
(As Leonard discusses in his post, we are well aware that certain conditions require surgical intervention. By no means are we saying surgery is a bad thing. We are simply bringing light to certain conditions that respond positively from conservative management.)
2/10/2014 02:03:12 am
The true reason for a placebo is to see if a patient has benifit when no procure is conducted at all. This study was not a true placebo. The patient had surgery. Surgery is a procedure. I speculate that the patient may have actually experienced true physically and mechanically improved as a result of the trauma and recovery from the sham procedure. Is it the the removal of the meniscis or the act of creating a healing response in patients that works? As PTs, we may be better equiped than orthopedic surgeons to get most "meniscis tears" back to full function, although, some cases of mechanical block, clearly need surgery to clear.
2/15/2014 12:08:54 pm
2/16/2014 10:15:28 pm
Thank you for your reply and I agree with your comments. I am certified to perform Dry Needle Therapy and one of the speculated theroys behind why we see improvement during Dry Needling is that we create a miro lession and generate a healing response by the body. The Mosely study you reference may be affective simply by creating a lession and the body has a natural response to recover. In doing so, the body heals all neighboring areas in distress. Pretty cool stuff, but more than a placebo I think.
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