Manual Therapy (2000) 5(3), 131

# 2000 Harcourt Publishers Ltd

doi:10.1054/math.2000.0353, available online at http://www.idealibrary.com on

Editorial
tempting to treat conditions such as low back and
neck pain as homogenous acute, subacute or chronic
syndromes, as is evident in some clinical guidelines, is
fraught with diculties. There may be evidence for
a certain treatment approach but its applicability
across the spectrum of even broad subgroups must be
carefully evaluated.
There has been an increase in the number of
clinical trials in response to calls for evidence based
practices. This is a positive move. At the same time,
consumers of this research must appraise whether
relevant interventions have been tested on appropriate populations. What seems to be emerging from
many clinical trials is that a certain percentage of
patients will respond to a given treatment and others
do not, which reects clinical practice.
As indicated, one of the main challenges to
clinicians and researchers especially in the area of
management of non-specic low back and neck pain,
is the need to be able to classify patients with more
certainty, to predict the responders and non-responders to a certain method of treatment. Pathoanatomical diagnoses are uncertain and unhelpful at this
time. Some predictors of poor responders are
available, especially in the psychosocial eld, but
these do not account for many of the patients seen
in daily practice. By and large, gross measures of
physical impairment have to this time been proven to
be of limited value. Yet it is this area of physical
impairment where practitioners of manual therapy
have detailed knowledge and have daily experience
with patients who respond and do not respond to
certain interventions.
This knowledge needs to be harnessed to formulate
new research questions. Can clinical patterns of the
nature and degree of physical impairment better
recognize responders and non-responders to physical
interventions? It is important that such questions are
investigated, in order to make a further and perhaps
very valuable contribution to the current processes of
testing and implementation of evidence based practices.

Evidence based practices: the need for new research

directions
In the Editorial of the previous issue of Manual
Therapy, Dr Kevin Singer correctly highlighted the
need for professionals to respond to the stringent
demands placed on them in this era of `evidence
based practices' and to align their practice according
to the best available evidence.
There is little dissent to the principals of evidence
based practices and the need for research into current
practices has been acknowledged and embraced by
health care practitioners. There is little more satisfying than to read the results of a clinical trial which
proves the ecacy of a treatment approach that we
are currently using in clinical practice. However, what
of the evidence that is not supporting some particular
practice? Have we been incorrect in using the method
all these years, and indeed this may well be the case
for certain practices, or are there limitations to the
research?
A factor to appreciate is that the randomized
controlled trial is but one method of research, albeit
an important one, that contributes to evidence based
practices. Other research methodologies are equally
important, for example, those which investigate
questions of mechanisms of action of interventions
which often cannot be answered in the design of
conventional clinical trials of treatment ecacy.
Research methods investigating epidemiological aspects of injury and disease also make a valuable
contribution to the evidence base. An area that is a
particularly important one for practitioners dealing
with conditions such as the so called non-specic
back and neck pain, is research directed towards
identifying the patients for whom a certain intervention is relevant.
The need for such research is becoming very clearly
evident as evidence based practices are being implemented into patient management schema. There is
a burgeoning of clinical practice guidelines, which, in
themselves, can be helpful in guiding patient management if constructed in a careful and relevant way
on the evidence available and implemented using
clinical experience and knowledge. However, at-

Gwendolen Jull and Ann Moore

Co-editors

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