What's a clinician to do when the rules of certainty….uhmm, aren't certain?
What do we use then to know we "know" what our patients need?
Well, that's the conundrum the certainty crowd faced with this report in June 2010. Now the certainty slips even further away with this report in June 2011 on CPR's for LBP.
"The current body of evidence does not enable confident direct clinical application of any of the identified CPRs."
Clinical prediction rules in the physiotherapy management of low back pain: A systematic review Robin Haskins, Darren A. Rivett, Peter G. Osmotherly
Critical Appraisal of Clinical Prediction Rules (CPR) That Aim to Optimize Treatment Selection for Musculoskeletal Conditions
Vol. 90, No. 6, June 2010, pp. 843-854.
Turns out there's no "good" evidence there is evidence that CPR's provide much direction or surety in treatment selection in PT.
Yikes!
I blogged about the shortcomings of this whole perspective back in April here in The Player Piano.
To my way of seeing this world, the whole fear-based scramble for certainty strips rehab of its vitality and creative process, short circuiting innovation and what Seth Godin describes as art in his latest book Linch Pin.
Surely we can invest more time and effort into innovation than we do in predicting? Failure to do so robs the next generations of rehab students being prepared to offer care that feeds them literally and spiritually as I wrote in May here on PT Education: A formula for craziness.
So where do you turn now that there isn't a map of surety?
I have some ideas as my mission is to return the sarcredness or artistry back to rehab, but want to hear yours…
what now?
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Tags: certainty in rehab, evidence in PT