Her er et fantastisk innlegg fra en fysioterapeut. Dette er så spot-on at han ble kalt inn på teppet av ledelsen på sitt undiversitet og forsøkt kneblet. De mente han burde ha ventet med å skrive slikt til han hadde minst 5 år mer erfaring. Noe som bare viser hvordan autoriteter mangler evne til fleksibilitet, og at såkalte evidensbaserte behandlingsformer ikke greier å tilpasse seg ny forskning. Fysioterapi henger 50 år etter. Jeg har samlet alle referansene for lettere tilgang.

http://blog.theravid.com/patient-care/redefining-evidence-ebp-in-experience-cut/

How does one justify the use of ultrasound when the biophysical (Baker et al 2001) and clinical (Robertson et al 2001) effects have been so thoroughly disproven?

• A Review of Therapeutic Ultrasound: Biophysical Effects http://ptjournal.apta.org/content/81/7/1351.long
• A Review of Therapeutic Ultrasound: Effectiveness Studies http://ptjournal.apta.org/content/81/7/1339.long

Why are we still taught that we are molders of connective tissue, when the forces required to create plastic deformation of connective tissue ranges between 50 and 250 pounds of force (Threlkeld 1992)?

• The Effects of Manual Therapy on Connective Tissue http://ptjournal.apta.org/content/72/12/893.long

When are we going to accept the fact that our palpatory exams lack reliability (French et al 2000) (Lucas et al 2009)

• Reliability of chiropractic methods commonly used to detect manipulable lesions in patients with chronic low-back pain. http://www.ncbi.nlm.nih.gov/pubmed/10820295
• Reliability of physical examination for diagnosis of myofascial trigger points: a systematic review of the literature. http://www.ncbi.nlm.nih.gov/pubmed/19158550

and validity (Najm et al 2003) (Landel et al 2008) (Preece et al 2008)?

• Content validity of manual spinal palpatory exams – A systematic review http://www.ncbi.nlm.nih.gov/pmc/articles/PMC156889/
• Intertester Reliability and Validity of Motion Assessments During Lumbar Spine Accessory Motion Testing http://ptjournal.apta.org/content/88/1/43.long
• Variation in Pelvic Morphology May Prevent the Identification of Anterior Pelvic Tilt http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565125/

When will we stop telling students, colleagues, and patients that pain is related to their posture, muscle length, muscle strength, or biomechanics (Edmondston et al 2007) (Lewis et al 2005) (Nourbakhsh et al 2002)?

• Postural neck pain: an investigation of habitual sitting posture, perception of ‘good’ posture and cervicothoracic kinaesthesia. http://www.ncbi.nlm.nih.gov/pubmed/16963312
• Subacromial impingement syndrome: the role of posture and muscle imbalance. http://www.ncbi.nlm.nih.gov/pubmed/16015238
• Relationship between mechanical factors and incidence of low back pain. http://www.ncbi.nlm.nih.gov/pubmed/12322811

When will we cease blaming pain on something found on an image (Reilly et al 2006) (Beattie et al 2005) (Borenstein et al 2001)?

• Dead Men and Radiologists Don’t Lie: A Review of Cadaveric and Radiological Studies of Rotator Cuff Tear Prevalence http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1964063/
• Abnormalities identified in the knees of asymptomatic volunteers using peripheral magnetic resonance imaging. http://www.ncbi.nlm.nih.gov/pubmed/15727883
• The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects : a seven-year follow-up study. http://www.ncbi.nlm.nih.gov/pubmed/11568190

When will we stop thinking that we can change someone’s static posture with strengthening (Walker et al 1987) (Diveta et al 1990)?

• Relationships Between Lumbar Lordosis, Pelvic Tilt, and Abdominal Muscle Performance http://ptjournal.apta.org/content/67/4/512.long
• Relationship Between Performance of Selected Scapular Muscles and Scapular Abduction in Standing Subjects http://ptjournal.apta.org/content/70/8/470.long

When we teach these things to students and say them to our patients, it is misleading at best and fear inducing and hurtful at worst (Zusman 2012).

• Belief reinforcement: one reason why costs for low back pain have not decreased http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3663473/

“In My Experience”remain the three most dangerous words in medicine.

This is perhaps even doubly so in the world of physical therapy, given the litany of non-specific effects that go into a treatment encounter (Hall et al 2010) (Miciak et al 2012).

• The Influence of the Therapist-Patient Relationship on Treatment Outcome in Physical Rehabilitation: A Systematic Review http://ptjournal.apta.org/content/90/8/1099.long
• A review of the psychotherapeutic ‘common factors’ model and its application in physical therapy: the need to consider general effects in physical therapy practice. http://www.ncbi.nlm.nih.gov/pubmed/21913950

Physical therapists are in a unique position to make a significant impact on the burden of chronic pain, however, we fail to live up to our potential by holding onto a postural-structural-biomechanical model that has been proven ineffective and incorrect (Lederman 2011).

• The fall of the postural-structural-biomechanical model in manual and physical therapies: exemplified by lower back pain. http://www.ncbi.nlm.nih.gov/pubmed/21419349

We need to familiarize ourselves with the work of people like Ronald Melzack, Patrick Wall, Louis Gifford, David Butler and Lorimer Moseley.