Evidence-Based Physiotherapy

The 'E' Word.

Maybe you’ve never heard the word. Or maybe you have heard it, but it’s never passed your lips. Regardless, this term is going through your physiotherapist’s head all the time. Sometimes it’s a comforting wave of warmth; on other occasions it’s a burning feeling of doubt. Nonetheless, it’s an important concept which should be addressed and appreciated.

Evidence.

It could be considered the key to ‘the truth’. Scientific studies are being conducted on a daily basis, to ensure that the treatment a physiotherapist suggests and prescribes is actually effective. It’s the basis behind which your physio has suggested you commence Clinical Exercise for your back pain, receive dry needling for your tendinopathy or avoid using anti-inflammatory medication after a muscular tear. Thousands to millions of patients, just like you, have been observed and monitored over time; their data recorded to measure whether the treatment they received from a physiotherapist has had a ‘real’ effect. Once a physio can be sure that something will work, they will suggest it to you as an option for managing your injury.

Professional Development

But ‘the truth’ is not static. As the range of options for physiotherapy treatment grows, so too does the body of evidence surrounding it. New studies are being conducted every day, and therefore new evidence - both for and against current treatment approaches - is being published just as frequently. Your physio has the responsibility to stay up to date with current evidence, a task which isn’t easy whilst also working a 40 hour week. It is likely that your physiotherapist has regular, informal in-house professional development sessions with their colleagues, in which they might discuss new techniques they have seen or heard about. They also, to remain accredited, are required to complete a certain amount of formal courses or lectures, from ‘experts’ or physiotherapists who have conducted research. All of this is unpaid. Moreover, attending most formal courses is at the physiotherapist’s expense.

Evidence doesn’t only drive a physiotherapist’s choice of treatment, it also is the force behind larger scale decisions. This ‘proof’ behind physiotherapy from large, high-quality studies is the reason behind why some physiotherapy sessions can be claimed on Medicare. It’s also the reason why physiotherapists make up a large proportion of the allied health team in public hospitals. In the governmental health system, evidence is money – and we all know money is scarce.

Research in the Field of Physiotherapy

But conducting high quality research in the field of physiotherapy isn’t an easy task – it isn’t easy in any field, but physiotherapy presents its own unique challenges. There’s no simple ‘physiotherapy pill’ which can be studied – with a regulated formulation and dosage. Every physiotherapist massages with different techniques, probes you with dry needles at different angles or prescribes you slightly different Clinical Exercise exercises – one method isn’t necessarily better than another, but it’s important for researchers to tease out subtle differences and try to control them, to reduce the possibility of confounding variables which may skew results.

It is for this reason that there is often a lag time with evidence. Clever physiotherapists may pioneer a new treatment option (take kinesiotape, for example), but it can take years before a researcher sees it used enough to warrant putting the time and money into conducting a good quality study about it. Then, physiotherapists, being the careful creatures they are, usually like to see at least a few separate studies proving the validity of the said treatment option, before they can really be sure of its benefit.

Therefore, whilst wading through this lag time, a physiotherapist can only use what they themselves have observed in regard to newer treatment options, as the basis behind their decisions. This is called “Empirical Evidence”; and it’s a perfectly acceptable form of evidence to be used.

Ask for Evidence

So, next time you see your physio for treatment, don’t be afraid to use the E word. I encourage you to enquire about the research that has been done, or is being done, about the treatment your physio has prescribed. I also urge you to pose this question when you hear about other treatment options on the internet and on social media; such as new diets or exercise and health regimens. A lot of work is put in “behind the scenes” to your physiotherapist’s decisions, and it’s important to make sure that the same amount of work goes into any other decision that is made about your health.

 

Julia Sewell - Physiotherapist (Clinical Associate), Back In Motion Camberwell

Julia graduated with honours from the University of Melbourne in 2010. Prior to joining the Back In Motion Camberwell team in 2011, she worked as a physiotherapist at both the Victorian Rehabilitation Centre and the Xavier College Rugby Club. During her time at Back In Motion she has developed more of an interest in dancers and dancing injury, and has undertaken extra training to conduct pre-pointe assessments.