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Toni Talks about PT Today

In Defense of Experience

Published July 2, 2008 8:52 AM by Toni Patt
Last week I found myself in the position of defending experienced therapists, specifically those who have been practicing 15 years or more. I was talking to a newer graduate, SB. He was finding fault with therapists who have been practicing awhile but haven't kept up with trends arising from internet access such as evidence based medicine (EBM). EBM is a topic for another day. SB was complaining about another therapist. This therapist told him she didn't see why she should find new techniques when the ones she currently used were effective.

Before I go further, I need to point out that SB missed the whole point of EBM. By definition, EBM is practicing medicine based on evidence. To be simplistic, research is considered the source of evidence. However, if a treatment is effective, and has been effective, that is a form of evidence.  One of the tenets of EBM is clinical judgment, a part of which comes from experience.

To continue with SB, he couldn't believe this therapist didn't want to rush to the internet and research new treatments. I'm paraphrasing what he said to me-that everyone knows about Goggle. Look it up there. Before he makes that statement, SB needs to take a few things into consideration. While SB grew up with computers, they are something new to my generation. Many people aren't comfortable using them.  There are people who don't own a computer.  I don't know if SB has ever done a Goggle search for PT related topics, but Goggle isn't a good choice. It pulls up consumer oriented Web sites.  That isn't the kind of search he wants to do.

If someone wants to research PT topics, access to a database is needed. The APTA offers this through Open Door and Hooked on Evidence, but membership is required. Access is also available to someone taking university level courses. The average PT has neither.  Young or old, if you don't have database access, research is difficult.

SB also needed to understand that our generation grew up in a different environment.  We were educated differently. We were taught to think differently. I made it a point to research continuing education opportunities before I wrote this. I didn't see one course for EBM.  Nor did I see any educational opportunities on explaining how to search a database. This is a skill I recently learned. There is more to it than simply typing in a subject.

Finally, I need to point out to SB that for every article that says one thing, another can be found that says the opposite. A skillful researcher can massage data to say anything.  Not all articles are written equally or based on equal science. If SB has an article that supports his opinion, he can say he has evidence on his side. I can say the same thing if I have an article that says the opposite. One good random control study discounts 10 poorly done studies.

I told SB to be less judgmental. He needs to respect experience for what it is. In my 20 plus years I've learned what is effective and what isn't by trying it. The therapist he spoke to may have done the same thing. Maybe next time SB could offer to help with a search. Then he could help solve the problem instead of contributing to it.


EBP is a whole package, not only parts when one feels like it.  EBP is incorporating patient values- meaning discussing with the client the current outcomes to various treatment options and asking them what treatment they would prefer to go with.  EBP is incorporating clincial experience- meaning discussing the clinicians personal clinical experience with outcomes and making recommendations; this also incorporates with using current literature as evidence for treatments one recommends, literature that provides evidence for diagnosis, literature for prognosis, and may well be systematic reviews of evidence that compile many valid studies together to pool a meta-analysis of the evidence.  

Your student, SR, is correct in talking to the therapist about the need to incorporate literature reviews for evidence with treatment in clinical practice now days.  Yes, the therapist has vast years of experience with great outcomes I am sure, however the patients of today are asking for part of the decision making power.  Each client has different values and it is time to recognize this.  There is no specific cookie cutter for all.

Learning how to incorporate EBP into ones professional employment is not a simple weekend course.  I use to think that learning how to ask a clinical question and searching for the data was all there is to it.  WRONG!   There is the process of learning how to critically analyze the data.  Not all data is valid.  Learning how to critically analyze requires learning how to do the statistical calculations and understanding what they mean.  For example one may find data with non-significant P-values, however one may find something of value in the data despite.  

Laurie July 25, 2008 2:56 AM

I'm a non-traditional older PTA student.  My undergrad days were pre-computer.  I do use a computer today.  I'd like to say that google (or you favorite search engine) does find many good resources, although usually not full journal articles.  All of the government health databases can be found through google searches.  Google searches have been a lifesaver for me, just watch the quality of your sources.  As a student I have access to the university library databases and as an APTA member I have access to their databases.  I find that I use our large metropolitian library database (got the library card on-line) and have found that their database is as good as my school library and easier to use.  While I do research from all three sources, by far my favorite is the public library database.  So I'm an old dog who has learned how to use a computer.  All public libraries have computers available for public use, I expect most have access to databases with a library card number, so happy researching :)

Laura July 12, 2008 8:17 PM

Good blog. Keep it up. It's useful to be able to read about actual observation and experience. Many things that look good in research don't work in practice.


Jennifer Jarratt July 2, 2008 9:35 AM

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