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72 m a s s a g e & b o d y wo r k m a rc h /a p r i l 2 0 2 2 One of the most contentious issues in discussions of manual therapy is the question of how far its many applications are and are not evidence-based. Fraught debates and outright controversies have led to some practitioners stating that some manual therapies should not be used at all since the evidence supporting them is poor or absent, while others insist that clinical experience and what evidence does exist is sufficient to support their ongoing application. Some practitioners use the description "evidence-informed" to refer to approaches that take evidence into account, balancing it with clinical experience and patient preference, but the term is interpreted differently depending on the practitioner's background and perspective. Unfortunately, both terms continue to be misunderstood, misused, and misapplied, with severe consequences for interprofessional relationships, reputations of whole professions, and patient outcomes. This debate has been ongoing since the 1970s, yet rather than moving toward resolution, practitioners across the manual therapy professions seem to have become more divided than ever. This may partly be due to the polarizing nature of social media debates and the damage they have done to our collective attention spans, and partly due to market pressures. Yet, these conflicts are more damaging to patients, professions, and their communities than any modality with thin research evidence (but considerable experiential success), because the debate is being led by neither science nor common sense. Whatever the reasons, the shrillness of the debate and the noise it is generating breach a fundamental rule of health care: Do no harm. Whatever one's position in the debate, that alone should be a good enough reason to pause for thought. THE DEFINITIONS In a 1996 article, "Evidence Based Medicine: What It Is and What It Isn't," David Sackett and his co- authors reiterated the definition of evidence-based medicine: "The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients." The authors further qualified this by stating, "It's about integrating individual clinical expertise and the best external evidence." 1 essential skills | SOMATIC RESEARCH What Exactly is Evidence? . . . and what do we do with it? By Sasha Chaitow, PhD TAKEAWAY: A contentious issue in the manual therapy profession is about whether specific applications should be evidenced-based or if clinical experience is sufficient. Promoting evidence- informed medicine within manual therapy professions may be a key way to walk in step with the medical community.

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