The Dangers of Evidence-Based Practice

Let's start by saying that we fully advocate for the further development of research to better guide our decision-making as physical therapists. This is without a doubt a touchy subject. Throughout schooling, we are taught to have our care as evidence-based as possible and we should be wary to perform any interventions or tests that are not supported by the literature. There lies an issue in this mindset, however: the quality and lack of research.

An obvious component we are trained to look for is how the study was performed. There are many different items to consider when appraising the research, such as type of study, blinding, controls, etc. Something that is often overlooked is the skill of the practitioner. There are hundreds of schools and many different methods of evaluating/treating patients. The gap between an OCS therapist and FAAOMPT therapist is significant. There lie differences in the skills of Fellows from different Fellowships due to variations in treatment styles again. Basically, what we're saying is that you should be careful to disregard treatment styles due to "evidence." If you know you are getting changes that are effective, you owe it to keep treating your patients the best way possible.

The next issue is the lack of research on exam measures and intervention techniques that we use in the clinic. We have had our mentors and fellow clinicians comment on where the evidence is for some of our treatment styles. A perfect example is Instrument Assisted Soft Tissue Mobilization (IASTM). While there is some initial research out there currently, there is hardly enough evidence to prove that IASTM is a high-quality, proven treatment. That being said, the results can be impressive. The key comes back to test and re-test your patients after a treatment. This applies to more than just IASTM. With your corrective exercises, joint mobs/manips, etc., assess your patient first (pain, ROM, strength, symptoms, SFMA) and re-check afterwards. Going back to IASTM, we have had particular success improving ROM without neural provocation using IASTM. Utilizing the neural tension test as our base and then follow-up, we have seen gains in ROM by as much as 45 degrees after simply a few minutes of IASTM. Basically, if you can prove that a treatment works by doing this, why stop it? Of course, we can't forget about incorporating these changes into our care and reinforcing them to lock in the changes, but the lesson is we shouldn't limit ourselves by what the literature is (or isn't) saying at the time.