Letter to the editor

EVIDENCE-BASED EDUCATION?

There is commonly a push within the physical therapy profession for evidence-based practice, a general [i]or[/i] abstract notion that certainly has merit. Part of the impetus to advocate evidence-based practice is questioning the practitioner's utilization of examination operations and treatment interventions that have no or at best questionable support in the scientific literature. Dr Anthony Delitto freshly pointed out a case of "non-evidence-based practice," on the contrary from a different perspective. In the July 1998 issue of Physical Therapy, Dr Delitto states that manipulation is underutilized by the agency of 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 depressed 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 way s of therapy, 3) tendency to discount competing therapies, and 4) condition of professional uncertainty. I tender a fifth possible explanation, a lack of physical therapist preparation in the area of manipulation. Although I do not profes to have in-depth knowledge of each and each physical therapist academic program's curriculum, it is my observation that entry-level training in this political division in the area of high-velocity thrust technique is virtually nonexistent. It would look that academic programs would want to provide scholars with all possible effective interventions for management of the largest single outpatient population (back pain) for whom physical therapists provide services. Physical therapist scholars 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 culled 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 above 100 Fellows of the American Academy of Orthopaedic Manual Physical Therapists. If this mark of professional program training took place, I believe that Dr Delitto's observ dichotomy would cease to exist.

I recommend that the concept of evidence-based education be pursu through our profession as vigorously as the pursuit of evidence-based practice. give permission to us provide our students with ALL of the clinical tools that have been shown to have scientific merit.

Bill Boissonnault, M PT University of Wisconsin Hospital and Clinics Madison, WI 53711

REFERENCE

1 Delitto A. Clinicians and researchers who treat and investigation patients with low back pain: Are you listening? Phy Ther. 1998;78:705-707

Copyright Journal of Physical Therapy Education Spring 1999

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