Is physiotherapy/physical therapy an evidence based field?

J

Jaybee00

Senior Member (Voting Rights)
I’m asking this question in general, not specifically limited to ME/CFS.

Just imagine how hard it is to do RCT blinded studies on these various treatments.

I’m sure that there are one or two small areas where there might be a good evidence base for specific treatments, but in general, I’m not so sure. We tend to hear endless anecdotes from people who swear that their therapist worked miracles to get their knee working, but of course in these circumstances we don’t have any comparison to people with no treatment but who experienced the healing effects of time only.

IIRC @Jonathan Edwards has expressed skepticism with respect to the rigor/evidence level in this field.

{{prompted to bring this up because I’m going to be forced to do extensive PT to “rehabilitate” my fractured leg}}
 
Worthless for my elbow and made it worse, worthless for my knee and made it worse, worthless for my shoulder and made it worse. Doing NOTHING allowed me to live a pain-free life. All three joints get aggravated quicker than my healthy joints so maybe/allegedly building muscle could help, but the process of building muscle means the pain flares up which takes weeks if not months to subside. I did a lot of nothing even before ME/CFS and it has always served me well.
 
Physio was necessary for a femoral head that used to sublux regularly. It doesn't go back into place on its own; if left untreated it triggers muscle spasms that cause long lasting sciatica.

That's been the only benefit I've had, though. NHS physios attempting to treat an overuse injury made it so much worse I was unable to lie down for weeks, and cost my employer thousands in sick pay.
 
Another minor physio anecdote for the pile:
I broke my finger and the doctor splinted it straight for a couple of weeks. When the physio later took off the splint the finger wouldn't fully straighten. We both just stared at my droopy finger and the physio (who seemed perfectly nice) was basically like "Well, I'm not sure what's wrong, it's not supposed to do that." And she offered to refer me for surgery. I suggested I'd just put it back in the splint for a week or two (imagining maybe the ligaments would shorten in that position?). No idea if my reasoning was correct, but luckily enough, when I took it off the second time my finger was all back to normal.

So, no harm in the end, but felt like I dodged an unnecessary surgery.
 
I was an athlete for many years including national team level and have had many injuries including 6 broken bones. I've experienced good and bad physio.

One crash I had put my pelvis/SI joint out of alignment and I could not walk afterward. I assumed I was out for a season, but in one treatment they identified the issue and adjusted it. I was improved 90% the day of treatment. They provided exercises to reinforce the treatment and it healed 100%.

In another instance, I dislocated my shoulder and the surgeon left my shoulder unstable after surgery. Without confirming stability, he sent me for physio. They failed to notice my shoulder had remained dislocated and treated me for 4 weeks before an X-ray revealed the persistent dislocation. That shoulder is ruined forever.

Oh what I would give to be able to throw myself down the side of mountains again :laugh:

Of course it's difficult to test relative to control. I'm not an expert but it's based on mechanics where you can frequently see/test/prove what is wrong. As (rightly) salty as pwme are, physio has a lot to offer when practiced well imo.
 
Almost all treatment provided by physiotherapists is not based on reliable evidence. There are a few areas where there are a few useful trials that allow some meaningful conclusions to be drawn but even then a lot of questions tend to remain.

The norm is that physiotherapists have no understanding of what is needed for reliable evidence and almost everything they recommend is probably a waste of time. It is a continuation of what internal medicine was like before 1950 (not so very long ago).

The interesting thing is just how convinced people are that physio was useful for them, despite there clearly being inadequate evidence in the absence of any control observation.
 
I had a few sessions of physio after a broken bone in my shoulder. It seemed a bit helpful to me as it encouraged me to gradually build up moving my shoulder through its full range of movement, starting with passive movement, then active, then against resistance. I have no idea, of course, whether just leaving it to me to start using it again would have been just as good. All I know is it recovered fully, and I was given confidence to start movement while it was still painful, rather than being scared to move it.

The other use I've had friends appreciating was gentle leg strengthening exercises to reduce falls in elderly people. I really need to do some myself. My legs have got frighteningly weak in recent years. I don't need a physio for that, I need to find a way to do it without triggering PEM.
 
I had several sessions of physiotherapy when I hurt my calf muscle playing tennis. Turns out my glute muscles were not pulling their weight which in turn caused the calf injury. I went through several sessions to activate and strengthen my glutes despite also being a regular gym goer at the time. I thought I had been strengthening my glutes via squats for years but instead it was the forward-chain muscles taking the bulk of the work. So my one interaction with physiotherapy worked very well for me.

Interestingly, it was after that injury that I noticed my very first symptoms although it wouldn't have been MECFS as that stage as there was no PEM.
 
Jaybee00 said:
I think in the USA orthopedic doctors will almost always prescribe PT for their patients for just about anything/everything.
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I think it's quite similar here, at least after major injuries or surgery. What's missing is evidence of how necessary, appropriate or useful it is.

A lot is based on assumptions, some of which probably date back to the aftermath of WWII.
 
Jaybee00 said:
Is this a view that is widely shared among physicians in the UK?
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I think a lot of physicians would agree to the fact that we have no reliable evidence base for most physio. That does not necessarily mean that they do not use physio services. Doctors are not always good at sticking to what they know t be reliable evidence!

Physiotherapists may have a useful role in encouraging people convalescing from surgery or acute illness to not be afraid to get moving, even if it hurts a bit. But even that i dubt we have reliable evidence for.

Surgeons have never taken much notice of reliable evidence of efficacy. Mostly they do operations because there is an operation to do, they like doing them and people pay and say thank you, even if often they are no better or worse. These days there are enough ueful operations to keep surgeons busy but when I trained orthopods spent much of their time doing useless procedures.

They prescribe physio because that means someone else has to manage the patient and they can get on with doing more operations.
 
Kitty said:
A lot is based on assumptions, some of which probably date back to the aftermath of WWII.
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There is clearly a weird sort of belief in it that persists even outside of the profession. I watched a TV series a few years ago, Away, where one character has a stroke and there's a whole storyline that is entirely about how rehab is the only way to improve, with another patient telling him that he must, MUST, do everything he can to not be discharged from rehab or he's done, will never walk again, will never live normally again, he's DOOOOOMED if he doesn't do everything to secure it, that he should even lie about improving because it's the only way to get better.

I found it weird at the time, almost like a disguised ad for rehab, and it feels even weirder seeing how little evidence there is for that. For sure it's not any better than the evidence for us, and the reasons might be the same.

It just seems to be part of popular beliefs about health being all about personal responsibility, how people must put all the effort they can into getting better, they must push, they must fight and never give up. Those narratives clearly exist within and outside the profession, and it's hard to understand where they even came from.

And boy are those narratives sinking us.
 
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