Letter to the editor
There is currently a push within the physical therapy profession for evidence-based practice, a concept that certainly has merit. Part of the impetus to advocate evidence-based practice is questioning the practitioner’s utilization of examination procedures and treatment interventions that have no or at best questionable support in the scientific literature. Dr Anthony Delitto recently pointed out a case of “non-evidence-based practice,” but from a different perspective. In the July 1998 issue of Physical Therapy, Dr Delitto states that manipulation is underutilized by physical therapists in typical outpatient clinical settings. t This is despite the fact that there is “compelling evidence supporting the use of manipulation for patients with acute low back pain.”l(P76) Delitto offers four possible explanations for physical therapists’ reluctance to provide a seemingly appropriate service: 1) rejection of existing literature, 2) excessive commitment to particular modes of therapy, 3) tendency to discount competing therapies, and 4) condition of professional uncertainty. I propose a fifth possible explanation, a lack of physical therapist preparation in the area of manipulation. Although I do not profess to have in-depth knowledge of each and every physical therapist academic program’s curriculum, it is my observation that entry-level training in this country in the area of high-velocity thrust technique is virtually nonexistent. It would seem that academic programs would want to provide students with all possible effective interventions for management of the largest single outpatient population (back pain) for whom physical therapists provide services. Physical therapist students should be taught the theoretical rationale for the use of high-velocity thrust technique as well as the indications, precautions, and contraindications. They should also be taught techniques for selected peripheral joints and the lumbar spine at a minimum. There are a number of therapists who are well-qualified to provide the instruction, including the over 100 Fellows of the American Academy of Orthopaedic Manual Physical Therapists. If this type of professional program training took place, I believe that Dr Delitto’s observed dichotomy would cease to exist.
I propose that the concept of evidence-based education be pursued by our profession as vigorously as the pursuit of evidence-based practice. Let us provide our students with ALL of the clinical tools that have been shown to have scientific merit.
Bill Boissonnault, MS, PT University of Wisconsin Hospital and Clinics Madison, WI 53711
1. Delitto A. Clinicians and researchers who treat and study patients with low back pain: Are you listening? Phys Ther. 1998;78:705-707.
Copyright Journal of Physical Therapy Education Spring 1999
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