The Sensitive Nervous System Chapter VI: Clinicians and Their Decisions

This is a summary of Chapter VI of “The Sensitive Nervous System” by David Butler. Intro All approaches (Maitland, Mckenzie, Mulligan) have myths. The common bond between them all is pain. Today we will look at building a clinical framework with pain as the cornerstone. Evidence-Based Medicine (EBM) EBM is defined as a conscientious, explicit, and judicious use of current best evidence in making patient care decisions. This concept is not merely reading researches articles, but it combines scientific evidence and clinical expertise. You have to know when to apply what. For manual therapists everywhere, this creates issues and unease. 1)      Decision making moves toward an external body. 2)      Evidence suggests manual therapy improvements are more psychosocial than physical. 3)      A disconnect between researcher and clinician. The researcher thinks: “What does this work contribute to the literature?” The clinician thinks: “What does this work do for my patient?” The movement towards outcome-based therapy per EBM is also problematic for several reasons. 1)      Clinicians begin to think statistical analysis becomes greater than any other form of knowledge rather than complimentary. 2)      Research doesn’t take into account the inherent uncertainty and subjectivity in a clinical encounter. 3)      Good evidence can lead to bad practice if applied in uncaring and unappealing environments. 4)      Outcomes may be coming out too quickly, leading to research development stopping in certain areas. Butler’s thoughts are summed up very nicely when he states it would be a sad day if meta-analyses have the final say instead of exposing

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