Physiotherapy as a clinical science: The role of single case research designs

Abstract

To an outside observer (a clinical psychologist), it appears that there is increasing pressure on physiotherapists (and other therapists) to evaluate, and hence justify, their interventions. Some of the pressure comes from purchasers of health care in today*apos;s market-led world. Some of the pressure comes from within the profession, reflecting a desire to ensure that physiotherapy maintains and develops its position as an applied clinical science. Indeed, it is surely a mature profession which has the confidence to scrutinise its methods, to identify in an objective and scientifically credible way which treatments truly benefit patients and which are likely to be a waste of time, effort and money. The clinical practice of all therapists is guided to a large extent by their own experience with patients as well as the experience of those who have taught them. However, an ‘apprenticeship’model of clinical development is acceptable only if the treatments handed down through successive generations of therapists have at some point been systematically evaluated. Ai Riddoch and Len-non (1991, p. 4) noted, ‘it is not ethical to administer unproven therapies’, and as Beswetherick (1994, p. 60) argued, ‘The physiotherapy profession needs to have a better understanding of the relationship between intervention and outcome where interventions are shown not to be beneficial we must stop their practice’, Personal recommendations from satisfied customers, be they the patient or the referring doctor, may ensure a steady flow of business, but they should not be sufficient for any profession which seeks to be an applied science and thereby offer more effective treatments.