Have you ever wondered about the evidence for physiotherapy? In fact, how do health professionals know what they do works? When I moved with my family interstate I had to change orthodontists. The new orthodontist said he would have made a different decision on what to do with my daughter’s teeth. Who was right, and why did they make different recommendations? Here at Sunshine Coast Neuro Rehab, we want to make sure that what we do is based on the best evidence.
Where does evidence for physiotherapy come from?
Do you remember in high school doing experiments? Well, evidence for physiotherapy also comes from experiments. In physiotherapy, scientists experiment with different types of treatments to see if they help people. We call these experiments “clinical trials”. These experiments or clinical trials are a good way of finding out if a certain type of treatment works.
There are different ways to design clinical trials, but the most common way is when scientists recruit or gather a bunch of people. give half of the people treatment and the other half no-treatment. The scientists test everyone at the start of the study, then re-test at the end of the study to see if people got better. They want to know does the treatment make people better. Even if the people who had the treatment got better and the people who didn’t get the treatment did not get better, the scientists want to be sure this is not a coincidence. To make sure it is not a fluke, the scientists take the information from the experiment, and crunch some numbers (called statistics), to make sure that the treatment really did make people better and it wasn’t likely to be a coincidence.
What makes a clinical trial trustworthy?
Scientists want to be confident that any information they get is trustworthy. Some of the ways they do this include:
- Tricking the people who are not getting treatment, by giving them pretend treatment (known as “placebo”) . If people think they are getting treatment, even if they are not, they sometimes feel better.
- Make sure the people in the experiment don’t know if they are getting the real treatment or pretend treatment.
- Randomly decide who gets the real treatment and who gets the pretend treatment. If the scientists got to chose who went in which group, they might put the people who they think will do well in the treatment group so they get better results.
- Make sure the people who are doing the tests don’t know who had the treatment and who had the pretend treatment. If they knew who had the treatment they might be biased when they take the measures.
Sometimes the scientists can’t do all of these things, because let’s face it, if the real treatment is exercise, “pretend” exercise is hard to give.
So are there different levels of evidence?
Yes. Even better than a clinical trial, is a systematic review. This is when a researcher asks a specific question, methodically searches for clinical trials, and then crunches the numbers from these trials. As you can imagine, if you can find several trials looking at a similar thing, you can be more confident in the results.
Scientists classify the level of evidence in various ways. Levels of evidence can loosely be classed into 5 categories
1 – Systematic Review or High Quality Randomised Control Trials
2 – Evidence from at least 1 large, well-designed randomised clinical trial
3 – Other Randomised Control Trials
4 – Case-Control Trials
5 – Expert Opinion
Some clinical trials are better than others, and you can be more confident in their results. Sometimes there are several clinical trials that study a similar thing.
What about when there is no evidence for physiotherapy?
Sometimes we see people who have rare conditions. Because these conditions are so rare, there is often little or no research done on them because there just aren’t enough people to do the research. Other times there may not be high-quality research, because it is not ethical to withhold treatment from people. When this happens, we base treatment on things like:
- Using our experience from treating other clients with similar conditions
- Talking about the condition with the clients other team members including their doctors, to make sure what we do is safe
- Reach out to other therapists who have treated people with the same or similar conditions to find out what helped and what didn’t
- Researching information about the condition, and using this with the knowledge we have of how the body works to help make the best decision
When we see someone with a rare condition, we will always be cautious about our treatment and recommendations, and closely monitor how people are responding to treatment.
How does SCNR keep up to date with the latest evidence for physiotherapy?
At SCNR we strive to keep up with the latest evidence so that we can provide the best evidence to our clients. All physiotherapists must do at least 20 hours of education each year to be able to keep their registration and call themselves a physio. At SCNR we encourage our staff to ensure this education is relevant to the people they see, to help them to find the best treatment they can give their clients. For example, I recently had a client see me with Huntington’s Disease. Because it had been a while since I had looked at the research, I spent time finding the latest recommendations for physiotherapy treatment for people with Huntington’s.
Some of the ways at SCNR keep up date with things include:
- Getting help from librarians to source the latest research.
- Regularly reviewing reputable guidelines that are based on the latest evidence.
- Attending online lectures and face to face courses that help us learn and improve our skills
- By signing up to receive relevant research in our inbox that has been reviewed by a rigorous process.
- Accessing reputable websites that share the most up-to-date information and recommendations. For example, there are websites on treatment for Spinal Cord Injuries or people who have had a Stroke. These websites are updated by experts in the field as new research is published.
We aim to hold firmly to our values at SCNR, including providing you with the best physiotherapy for your condition. If you have any questions about what is best for your condition, or would like to make an appointment, please call (07) 5448 115 or email admin@scnr.com.au
Rebekah McClellan
APA Titled Research Physiotherapist
References
Burns PB, Rohrich RJ, Chung KC. The levels of evidence and their role in evidence-based medicine. Plast Reconstr Surg. 2011;128(1):305-310. doi:10.1097/PRS.0b013e318219c171