In this article, we will discuss the treatment of physical therapists
There are two types of treatment choices made by physical therapists: those who practice the methods recommended by accumulating data, and those who base their treatment methods on unconfirmed evidence, or on their own claims.
How much do the results of the studies presented divide the results? What are the reasons? The following is a survey of the research that has been conducted.
Research Results
In the 94 studies referred to, there were
Back pain (n = 48 studies)
Knee pain (n = 10)
Neck pain, or whiplash (n = 11)
Foot or ankle pain (n = 5)
Shoulder pain (n = 7)
Before and after knee arthroplasty (n = 6)
Other (n = 18)
The survey was designed to investigate the treatment choices of physical therapists for these.
In summary, 63% of physical therapists provided recommended treatments for musculoskeletal conditions, 43% provided non-recommended treatments, and up to 81% provided treatments based on unconfirmed evidence.
Examples of recommended treatments include advice on maintaining activity and exercise therapy for knee osteoarthritis.Examples of treatments that are not recommended include electrotherapy for neck pain and joint mobilization for acute lateral ankle sprains.
In contrast to recommended therapies, the percentage of physical therapists providing treatments of unknown value seems to be on the rise.
Examples of treatments with insufficient evidence for low back pain include workplace intervention, myofascial release, cold therapy, relaxation therapy, and laser therapy.
Examples of treatments with insufficient evidence for neck pain include acupuncture, massage, and postural advice.
Why this is happening
Physical therapists are required to manage a wide range of conditions, and for some conditions, science has not kept pace with practice, so innovation is needed.
As an example, there is far less research into the management of conditions such as TMJ and cuboid syndrome compared to research into low back pain.
For conditions where the evidence base is relatively weak or for complex patient conditions, it may be necessary to try treatments of unknown value.
This is especially true when the response to an evidence-based treatment is weak, even when it is offered.Therefore, innovation is needed in clinical practice.
However, obtaining evidence through research and interpreting the findings can be time consuming.
For these reasons, many physical therapists believe that evidence-based practice is not important, that evidence does not improve the quality of treatment, and that it is not important for clinical decision making.
According to the results of a survey of 274 physical therapists in Canada, only 46% agreed that guidelines allow them to manage low back pain.
Only 52% agreed that physical therapists should not use electrotherapy for low back pain, and it was found that this was driven by the belief that clinical experience is more beneficial than research evidence.
The view from this survey was that some patients believe that non-evidence-based care is effective and therefore demand such care, and that blanket recommendations for non-evidence-based care are inappropriate.
Ignoring such patient demands can be a very difficult problem in a situation where you are trying to build strong communication with patients.
Another issue is where the guidelines are developed.
Even physical therapists who believe that evidence can be useful in practice recognize that it can be difficult to implement guideline recommendations when existing guidelines are being developed in countries with different cultures, health care systems, and levels of resources.
Zadro JR, Ferreira G. Has physical therapists' management of musculoskeletal conditions improved over time? Braz J Phys Ther. 2020;24(5):458-462. doi:10.1016/j.bjpt.2020.04.002
Measures and Summary
Evidence-based treatments are likely to be useful in improving symptoms, but as noted above, there are limited conditions under which they can be implemented.
However, as mentioned above, there are some conditions that make it difficult to practice. This is why there are many physical therapists who practice treatments that are not recommended, but we should also work to make those methods recommended.
Some guidelines are updated, so it is not uncommon for past common sense to be changed.
As an example, with regard to low back pain, the previous guidelines considered 80% to be non-specific low back pain, but now about 80% are considered to have some attributable cause.
Those who do not look at such things and believe only in their own experience are offering a deprecated treatment method, which may one day become the recommended method.
This is a problem that judo therapists should learn from.
(Because most of the treatments they offer are not evidence-based.
