When should evidence change practice? Part 4. How much evidence is needed to change practice?

Later in the discussion, another contributor ‘Ged’ reported that although research may influence the way he/she used an approach,  they weren’t going to “throw it [their Bobath practice] away just because one piece of research disproves it (unless there is significant evidence of harm)”.

RogerM replied: “ …. You imply that the Novak paper is just one piece of research and that it can probably be a balancing by another contradictory piece of research. This is not the case, the Novak paper is a review of ALL the high quality evidence (for and against Bobath); it therefore represents best evidence.  As therapists we do not have time to read and study all the individual research publications, but we should study the major reviews that summarise all the best current evidence…. I think we not only have a professional responsibility to take their conclusions onboard but (and more importantly) to act upon them”.  

Ged’s view was reiterated by the Children’s Bobath tutor who was not going to “stop Bobath because of some written recommendations …..….. Bobath practitioners achieve goals, and change lives, so I’m not going to give it up!”

I’ll leave the last word to Chris: “….I am concerned that any physiotherapist would feel that they cannot stop practising Bobath because of “some written recommendations”. I think for me, this statement has been the proverbial nail in the coffin with regard to my association with the Bobath approach. We cannot be selective in which evidence we chose to use and which we chose to ignore. When robust evidence such as the Novak review comes along we need to sit up, listen and modify practice. We cannot simply say “I know what I do works, I’m not changing and ignore best practice”. How long must we wait for high quality evidence supporting Bobath? As HCPC registered physiotherapists we are duty bound to offer the best evidence based treatment to our patients. I do wonder where one stands on the matter of professional registration for those who refuse to set aside their Bobath treatment strategies in the knowledge that better evidenced practise exists elsewhere. It’s important to remember we were all physiotherapists first before we studied Bobath and it should be used or discarded in line with the evidence base like any other treatment modality. For those therapists unwilling to part with Bobath, is it time for them to part company with Physiotherapy? It would appear that in fact it is Physiotherapy that has evolved not the Bobath Concept”.


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