PHYSIOTHERAPY TREATMENTS MAY NOT BE AS VALID AS PATIENTS ASSUME THEM TO BE
Murray, I. R., Murray, S. A., MacKenzie, K., & Coleman, S. (2005). How evidence based is the management of two common sports injuries in a sports injury clinic? British Journal of Sports Medicine, 39, 912-916.
This study examined the diagnosis and management of adults attending a sports injury clinic, to establish to what extent the management of the two most common injuries treated at this clinic is evidence-based, and to explore factors that affect management. A retrospective examination of 100 random case notes extracted age, sex, sport, type and site of injury, treatment, and outcome. Systematic literature reviews examined the extent and quality of scientific evidence for the management of the two most commonly presenting injuries. A clinical attachment period and practitioner interviews allowed recognition of factors impinging on management decisions.
It was found that Patellofemoral pain syndrome (PFPS; 10% of all injuries) and Achilles tendinopathy (6% of all injuries) were the most commonly presenting injuries. Clinicians reported that personal experience formed the basis of management plans in 44% of PFPS cases and 59% of Achilles tendinopathy cases. Primary research evidence only accounted for 24% of management plans in PFPS and 14% in Achilles tendinopathy. Practitioners were unaware of literature supporting over 50% of the treatment modalities they used. However, clinicians were often using evidence-based treatments, unaware of the supporting research data.
Implication. This study highlights a lack of evidence-base, a lack of knowledge of the research evidence, and a lack of management based on the current evidence that is available for these conditions in the treatment of injuries by physiotherapists. Practitioners practiced evidence-based medicine in under 50% of cases.
While this study evaluated one clinic, personal experience shows this could be a much greater problem than a defensive professional reaction might claim. Of similar concern is the type of programs offered by strength and conditioning coaches, many of whom were not outstanding students in their degree training, who rely on self-developed programs that often are contradictory to the implications of scientific evidence.
This study unlocks a door to investigating the actual benefits and value of supporting sport science and peripheral medical staff members on performance of athletes exposed to their presence. A jaundiced viewpoint would be that these auxiliary services in modern high-performance and professional training situations are more detrimental to athletes' health and performance than beneficial.
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