Physical therapy tools with the most scientific evidence
Several professionals of our team are university Physiotherapists, Kaenz Therapists, have been related to research, clinical, teaching and training in Physical Therapy; for the same reason, we have been able to appreciate different doubts in colleagues and students, who ask us the following questions as to the physical therapy tools:
What kinesthetic techniques are most effective in reducing pain? Does physiotherapy have scientific evidence? How much delay is the transfer of knowledge generated by university research to the application in public centers? Is it necessary to update my knowledge in kinesiology? Is the level of evidence the same as the grade of recommendation? Are physical exercise, manual therapy and physical therapy effective tools?
Next, we intend to provide answers to these and other very frequent questions, making these topics clearer, by approaching them in a professional and simple way for all our readers, as well as encouraging the discussion of this interesting and debated topic.
First of all… Is the same level of evidence and grade of recommendation?
The level of evidence depends on the type and quality of the study or scientific article that supports a hypothesis or affirmation; instead the grade of recommendation, focuses on applying that knowledge in specific.
It is necessary to clarify that there are several scales of levels of evidence and grades of recommendation, but the most used and endorsed is the Oxford Scale of the Center for Evidence-Based Medicine.
What should be applied or used in Physiotherapy, to deliver a quality and effective service to the user?
Independent of the physical therapy tools or technique used, the level of evidence supporting it should be analyzed, eg it is considered appropriate to rely on a level of evidence Ia (systematic reviews or meta-analyzes) and/or Ib (randomized controlled clinical trials) and grade of recommendation A (extremely recommended, based on a level of evidence I), according to the Oxford scale.
Taking this background into account, our kinesics approach is limited to a few tools and techniques that are more effective in solving health problems for our users.
What are the physical therapy tools, techniques or skills with a level of evidence I and grade of recommendation A?
It should be pointed out that it is extremely difficult to find a scientific study with a homogeneous sample in the area of neurokinesiology, since the motor control problems are very wide, even in users who suffer from the same injury.
Therefore, it would limit the investigations with a high level of evidence and sometimes we are based on a case study (level of evidence III or IV), the same thing happens in the intensive and oncological area; since ethically cannot be left untreated to these users (control group) or perform an alternative therapy with a lower grade of recommendation.
On the other hand, the physical therapy tools, techniques or skills with a level of evidence I and grade of recommendation A, which are based on several scientific articles of the last 5 years, can be divided into three areas:
1) Manual Therapy and/or Chiropractic, with a focus on users with arthro-myofascial-osteotendinous (AMFOT) alterations.
2) Adequate prescription of physical exercise, focused on users with cardiometabolic diseases and AMFOT alterations.
3) Some physiotherapeutic agents, such as electrotherapy (TENS, TIF and Russian currents), mechanotherapy, thermotherapy (hot wet compresses), cryotherapy (cold pack) and hydrotherapy (contrast baths, turbine, Hubbard tanks and swimming pool), for reduce body aches, controlling inflammatory processes, increasing muscle mobility and strengthening.
So, Is there Evidence – Based Physical Therapy?
The concept of Evidence-Based Health was first coined by Dr. David L. Sackett in 1990 (26 years ago), who founded the first department of Clinical Epidemiology at Mc Master University in Ontario (Canada) and The Oxford Centre for Evidence Based Medicine.
What has caught our attention is that the concept of Kinesiology or Physical Therapy based on Evidence has no more than 5 to 10 years and for many colleagues and students of physiotherapy, is a new trend, reflecting the obsolete of our knowledge (50% of our knowledge learned 6 years ago is in that situation), it is only a matter of reviewing the clinical guidelines of various ministries of health and review their bibliography that is sometimes 1980 and with a few basic lines of physiotherapeutic approach.
But most unfortunate, is that the main affected, are our users because of the poor service that is delivered, so it is everyone’s responsibility to look for the different options to stay current and apply that knowledge with discretion.
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Best regards and we are attentive to your comments.