art vs. science in physiotherapy

There is a conflict within physiotherapy between art and science. On the one hand the professions seeks to promote itself as modern, scientific and international but on the other hand it is heavily dependent on unproven methods introduced by charismatic individuals such as Maitland and Bobath. And charisma rather than science is the way that new ideas tend to be promoted. Usually what happens is that an individual will come to prominence through teaching their methods and then as popoularity for the methods grows someone decides that there needs to be research into why the method works for its enthusiastic pratitioners . In the past research has tended to be very much "after the event" taking place after the particular school of thought has already gained a lot of followers and usually after it is being promoted in post graduate courses.

There is a massive flaw in the profession's way of developing new practice. New ideas tend to spread on on the basis of their apparent effectiveness but initally this is never subjected to rigorous evaluation and the early perception of effectiveness is based on the subjective impression of the theraist using the techniques.There is a natural bias in interpreting outcomes [if this was not the case there would be no need for blinding in reseach trials]. Clinicians will tend to over-estimate outcome effectiveness. This is because something else is going on in the clinical situation, something which up to now has received very little attention in research. Therapists' behavior in the clinical setting is affected by their need to feel self esteem about their performance as a clinician. This means that the decision making process about clinical effectiveness is not an entirely rational process and there is something to be gained at an emotional level if the therapist thinks she is exercising great skill using a particular technique. The "emotional reward" achieved through clinical technique will create bias towards techniques which produce a high level of emotional satisfaction even if that technique might lack objective research to show it works; the combination of emotional satisfaction and perceived effective outcome ensures that the technique is continued. The charismatic promoter of techniques trades at an emotional level of acceptance before the rational processes are fully engaged. This emotional engagement creates a pathway for later acceptance at a rational, conscious level.