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Clinical Expertise in
Evidence Based Practice for
Pelvic Girdle Pain. Show me
the Patient!
(See below for who this course is aimed, course dates and previous participant
reviews)
Click here to apply
Every day in clinical practice, health care practitioners meet patients
seeking help for their pelvic girdle pain and loss of function and while we wait
for definitive evidence to guide our practice, treatment must go on. Clinicians
are keenly aware of the need to become evidence-based (EBM), but what does it
mean to be evidence-based in clinical practice? It appears that to many, EBM
means that a clinician can only use assessment tests and treatment
techniques/protocols that have been validated through the scientific process.
This is difficult to adhere to since we don’t have enough evidence at this time
and indeed could there ever be enough evidence for every situation met in
clinical practice? Sackett et al (2000) defines evidence-based practice as “the
integration of best research evidence, clinical expertise and patient values”
They also note that “External clinical evidence can inform, but can never
replace individual clinical expertise, and it is this expertise that decides
whether the external evidence applies to the patient at all, and if so, how it
should be integrated into a clinical decision”. What is expertise? According
to Ericsson & Smith (1991) “Expertise has been defined as having the ability to
do the right thing at the right time”.
Most clinicians resonate with Sackett’s definition and comments regarding
evidence-based practice since clinical expertise and deductive reasoning are
necessary to bridge the gap between what we know scientifically and what we need
to know practically to treat patients with pelvic girdle pain and loss of
function. In addition, Jensen et al (2007) note:
One of the
challenges in physical therapy has been the significant focus on the scientific
method that assumes the core tenets of the biomedical model as the most highly
valued forms of knowledge generation. For example, we are more likely to see
support in terms of grant funding and publication for a quantitative approach to
research in which the evidence of clinical success is quantifiable and measured,
such as the effects of a specific intervention on patient outcome. This
intervention is more likely to be a modality or exercise than any consideration
of the teaching skill and ability of the therapist. This quantitiative approach
is in contrast to more methodologically diverse approaches, such as qualitative
exploration of the patient-clinician interaction that may have a significant and
meaningful impact on patient outcome and function.
As
congresses focus on the much needed research-based papers, the contribution of
clinical expertise and patient values in the therapeutic process is decreasing.
In Melbourne, at the 5th World Congress on Low Back and Pelvic Girdle Pain,
Stuart McGill rightly noted this reduction and challenged us to “Show Me the
Patient!” This presentation/paper will try to do just that and comes from over
thirty years of reflective, research-informed clinical experience with patients
with low back and pelvic girdle pain. Evidence-informed tests of load transfer
through the pelvic girdle will be shown as well as specific tests for assessment
of the articular system, neural system and myofascial system. Subsequently,
clinical cases will be used to show how an integrated model is used to determine
primary impairments which have led to failed load transfer through the pelvic
girdle. We call this ‘solving the clinical puzzle’ and will present a system
based classification for patients with pelvic girdle pain which will facilitate
individualized prescriptive treatment which is evidence-based for clinicians.C
Course Dates
Clinical Expertise in Evidence Based Practice for Pelvic Girdle Pain. Show me
the Patient!
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