“The absence of evidence is not the evidence of absence”

TheKettleBellPhysioBlog, Uncategorized0 Comments

“The absence of evidence is not the evidence of absence” is often quoted in manual therapy, but what if there *is* evidence of no benefit?

Bronnie Lennox Thompson quoting Paul Ingraham:

‘I think biological plausibility and no evidence-of-absence is the minimum required for the clinical application of most ideas and techniques in manual therapy. Absence of evidence is the norm, and that’s fine. But if there is any trial evidence that shows no benefit, or damns a technique with very faint praise, that’s a deal-breaker. Or if the idea is clearly at odds with any well-established biology, chemistry, physics… that’s another deal-breaker.

And the bar quickly gets raised if the idea/technique is risky, if it’s costly, if there’s no informed consent. Clearly positive good quality and replicated trial evidence becomes necessary then.

Even in the absence of positive outcome trials, quite a few theories and techniques are “justifiable enough.”

A lot of people will probably be surprised to hear me say that, because I’m so notoriously critical of so many theories and techniques. 🙂 But there’s a very important distinction: what I’m critical of is OVERCONFIDENT CLAIMS OF EFFICACY. Pretending to know what no one can possibly know. THAT is what I object to. For instance…

I sincerely have no problem whatsoever with a therapist who says, “I do trigger point therapy, even though no one really knows what trigger points are. We have some theories, there’s some imperfect suggestive evidence, a bunch of controversy. No one really knows if we can do anything about them. It’s a crapshoot!”

But I have a huge problem with this kind of thing: “Trigger point therapy works! I understand this kind of pain and I can treat it. Now enjoy my magic hands, which are going to hurt by the way.” Yep. Huge problem with THAT. It’s really all about the framing and the humility.’

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