Evidence for Physiotherapy

OK so last post said that physiotherapy blog is going graphic. I've not forgotten this and I'm working on it, but having just visited a few blogs which talk about evidence based practice .I have a number of points to make. Firstly evidence based practice (EPB) is hard to put into practice within physiotherapy (at least in the UK) because these's a strong tide to fight against, and that tide is the (probably dominant) view that within clinical practice results are the most important thing; as long as people get better when we are "doing" something then we must be doing things correctly. There is also an uncomfortable issue with so called evidence There's evidence for everything within physiotherapy but the problem is the evidence is poor when weighed against the standards being used for evidence quality within other areas of healthcare. Often it's only professional opinion that's the evidence.Significant amounts of physical therapy theory lacks evidence but often what happens is an enthusiast for a treatment technique conducts a "trial" using a small sample , biased selection or fails to blind assessors to intervention and then when the results come back positive it it presented as proof that the technique or approach works. There's another weakness in EBP and that is often the poor critical appraisal skills of therapists. There's a willingness to accept anything which is "evidence" regardless how good the research methodology is. Perhaps the biggest problem is a relucatance to change clinical practice when good evidence becomes available, because the old practices "worked" and in the worst situation no one is aware that the latest evidence strongly supports a change in direction. Let's face it, no one (except an unethical clinician) would spend large amounts of time doing those things which obviously made no difference. The challenge for EBP is to extract the subtle changes and interactions which are occurring within the clinical situation and differentiate them from those changes and interactions which would occur in the absence of a specific clinical intervention. No small feat!