A case for responsiveness: Connecting moment-to-moment changes in palpation findings to end of treatment goals and outcomes

Abstract

The application of evidence-based-medicine (EBM) to manual therapy patients often culminates in the selection of an intervention or protocol for a particular condition. Recently the advent of clinical prediction rules has assisted to make the selection of interventions more specific to a patient rather than a condition, but still the application of evidence often does not extend beyond treatment selection. Some authors in the Physiotherapy literature interpret EBM to indicate that once a treatment decision is made, the clinician should then persist with their chosen course of action unless the particular patient's outcomes are 'very poor'. Most schools of thought within manual therapy however recommend the clinician be responsive to changes in a patient's condition over timeframes ranging from seconds to months or years. This paper will discuss the connection between the responsiveness of a clinician and particularly the last two elements of the EBM triad of best available evidence, clinical experience and patient values. An additional body of evidence is developing that supports responsiveness within the clinical decision-making process . As an example, a summary of our recent research related to the cervical spine will be presented . For patients with non-acute neck pain, immediate changes in specific aspects of stiffness of PA movements were found to be related to immediate changes in impairments. Immediate changes in impairments within a treatment session predicted between-session changes in impairments and changes within one or two treatment sessions predicted end of treatment outcomes. Responsiveness to patient changes can therefore be further justified, at least in non-acute neck pain, by the presence of a series of interconnected links forming an unbroken chain from immediate palpable changes in PA stiffness to end-of-treatment outcomes. Ethical approval was received for each study in this series from the human ethics committees of James Cook or Griffith University