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Its been a while since we went round the stump on this one and it keeps coming up, so...

There have been a couple of VP threads running recently. People have put forward a number of interesting ideas including banana skin and silicon sheets. Not included in the cochrane review because of a lack of RCT level EVIDENCE.

There is the thread on proprioceptive (sorry craig) phenomenon which observes a possibly new concept, or possibly nothing at all. We don't really know because we don't have EVIDENCE.

We have the droopy eyelid thread where we mock Brian for making exaggeratted claims with no EVIDENCE to back them up (unless you count 4 photos of people opening their eyes, Check out Robeer NCF, negative carbon footprint insoles, they're ace. But i digress).

There is the researcher vs the clinician thread in which the level to which Medial heel skives is supported by evidence is questioned.

There are the acupuncture threads. Plenty of evidence, diddly squat rational.

Less so on this forum because Australia and America appear less prone to accept the Next Big Thing but on the society forum we are once again doing the homeopathy debate. And looking for EVIDENCE.

I therefore wish to ask the Question

What level of evidence should we look for before we accept a treatment or new paradigm as USABLE in practice.

What level of evidence should we look for before we accept a treatment or new paradigm as ESTABLISHED.

As a proffession, what should our response be to modalities which have good anecdotal outcomes but lack an evidence base to support them.

Or any other relevant observations.

Regards
Robert

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My own view for what it's worth...

I am willing to try non rct supported modalities if i can see a rational behind them (ie Skives, removing HDs.) If my results are good i accept them as part of my toolkit.

I am willing to try modalities where i do not fully understand the rational but there is good RCT or comparative evidence to support it. (ie acupuncture). If my results are good i accept them as part of my toolkit.

I am not willing to accept modalities in which i do not understand the rational and there is no RCT evidence, even to try. I would not be confident defending my actions in court on the basis of somebody else's anecdotal evidence alone if something went wrong.

I am willing to accept modalities where there is no RCT evidence and i do not FULLY understand the modality if they are already being carried out as part of local standard practice with good results (ie LLLT).

Regards
Robert

Related threads:
Evidence-based medicine resources for clinicians
Does EBP and its pursuit have any drawbacks?

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Really, EBM boils down to academically (not clinically) derived concept of 'quality' of evidence.

The big things that grates on my nerves with EBM is that where an absence of evidence exists in health (ie anything not to do with drug treatments which get all the funding), then other levels of quality of evidence are poo-poo-ed and dismissed.

If we take enucleating a corn. I have yet to see randomised, double-blind control trial on this treatment (if it could be designed).

We know that there is a very long established consensus amongst thousands of clinical and academic peers that this is an appropriate method for dealing with this problem.

Until someone can prove otherwise, then THAT level of evidence should be considered just as valid as the gold standard. If all of my peers are saying that Method A is working for them, despite a RCT, then that's good enough for me. If it was ineffective or inappropriate, then patient complaints, law suits or market forces would tell you otherwise...

LL

This come close:
http://www.actr.org.au/trial_view.aspx?ID=1279

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Applying direct pressure on a hemorrhage is the recommended emergent treatment. However I failed to find a study supporting this. Based on EBM should we let those who are hemorrhaging exsanguinated while we standby waiting for evidence ?? I think common sense has a place in podiatric biomechanics and medicine.

No No No. You have got it totally wrong. You should at least do a literature search before you apply the pressure to make sure there is no evidence

The key quote from the other thread we had on Does EBP and its pursuit have any drawbacks? is this one from Sackett's book:
ie its about combining evidence with clinical experience.

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