Managing Information for Patient Care
Scientific information and studies about management and treatment for different conditions are synthesized into recommendations for medical clinicians. These are called clinical practice guidelines and exist for all types of conditions. They are often up-dated as new evidence becomes available, and are used by musculoskeletal practitioners as well.
An evidence-based practitioner uses these guidelines, where available, to help you manage pain or other conditions.
An evidence-based patient-centred practitioner helps you put evidence into the context of your individual presentation.
Low Back Pain, For Example
The recently updated low back pain guidelines recommend physical activity as a foundation for treatment. That recommendation is based on low to moderate quality evidence for an adult population with few co-morbid conditions. If you have low back pain plus other conditions like Ankylosing Spondylitis, Fibromyalgia or Chronic Fatigue, Arthritis, or Diabetes to name a few possibilities, any recommendations need to be modified to make sense for your situation. With Fibromyalgia or other chronic pain or fatigue, activity can make matters feel worse and would need to be adapted for your unique situation.
Adapting these recommendations requires collaboration with you, because as the person with low back pain your experiences, what you’ve tried and what has or hasn’t worked, what you want to get out of treatment, and what your goals are, is vitally important information.
Uncertainty and Consistency of Evidence
As an evidence-based patient-centred osteopathic practitioner I can't provide certainty for treatment outcome for any condition you are seeking help with. My language is conditional – may, might, could. There are no guarantees that a treatment will provide resolution. I won't tell you that you have a specific osteopathic problem or that I can fix it, for example. On the face of it, the advice I offer and what I say about how the treatment works is not particularly impressive.
But neither is the evidence.
It is consistent though. Statistically, the number of people who experience low back pain hasn’t changed for a long time. The number of people who go on to develop chronic low back pain continues to grow.((https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advisory-bodies/canadian-pain-task-force/reports-meetings.html)) This is despite the large number of claims made about different treatments for low back pain, which includes everything from medication to osteopathy to acupuncture and beyond.
It's not that we don't know anything at all. We do know that the average person has a back pain episode that goes away either on its own or with minimal other intervention. It's likely that if you are seeking treatment then you probably don't fit the average. That's where the conversation changes from what the evidence is to how it might or might not be of use to you.
Evidence-Based Patient-Centred Osteopathy
What is not well covered in the evidence is your experience as a patient.
At times, getting a hands-on treatment like osteopathy can seem like magic. You hobble in with pain and you walk out without pain with just one or two treatments. That can happen, absolutely, but the opposite can also be true at times, as well as everything in between. How many times have you seen a practitioner who initially worked miracles, but eventually their treatments stopped helping? Or you went to a practitioner who came highly recommended whose treatment seemed to make matters worse? That’s not because the practitioner doesn’t care or isn’t very good, it’s because the evidence on average shows limited positive effect.
Results Will Vary
Treatments can often have profound effects, especially when they help with pain and movement. Most of the time though there's a caveat in that immediate post-treatment effects for pain, mobility, and feelings of relaxation may not be lasting for those with chronic or more complex situations. This means we may both have to work a little differently to help you meet your goals:
- Do you need extra help, like a referral or further investigation to determine if an underlying condition is present?
- Would it help to temporarily modify or permanently change activities for management?
- Would you benefit from hands-on work like osteopathy, even if it's only temporary?
- Can I help you manage your condition without needing frequent treatment?
New treatments are constantly being investigated and new evidence for causes of pain and other conditions continue to emerge. An evidence-based patient-centred practitioner will keep up to date as much as possible, but, at this point in time the evidence provides us with some useful options and we can work together to figure out which of those options works best for you.