Academic journal article Indo - Pacific Journal of Phenomenology

Evidence And/or Experience-Based Knowledge in Lifestyle Treatment of Patients Diagnosed as Obese?

Academic journal article Indo - Pacific Journal of Phenomenology

Evidence And/or Experience-Based Knowledge in Lifestyle Treatment of Patients Diagnosed as Obese?

Article excerpt

Because research is one thing ... but retrieving experiences from my experience box - that has impacted my approach. ... When I started working with this, in the beginning, I was more like this: Now you have come to the right place. I was kind of like that. I felt the need to convince them that I know what I am doing.

This is Nora, a physiotherapist, working within the specialist health service in Norway in a clinic specializing in group-based interventions for helping patients diagnosed as obese to lose weight. As a sporty and fit physiotherapist, Nora started working in the clinic, eager to help her patients accomplish this. However, through encounters with various patients, she came increasingly to question weight loss as the ultimate goal for everybody in the group. Could it be that, through her efforts to help patients become more active, pushing their limits, she risked doing more harm than good? Could it be that patients' sense of failure intensified when pain and discomfort prevented them from keeping up with the rest of the group during intense interval training or long outdoor hikes? Grappling with such questions, Nora increasingly came to rely on her "experience box".

Nora's reference to an "experience box" as something different from research indicates that she has learned the value of relying on her own clinical experience as opposed to research when treating patients diagnosed as obese. This is interesting, given the emphasis on evidence-based practice (EBP) as a premise for physiotherapists' professional approach. Indeed, evidence-based practice is emphasized from the very start when students embark on their physiotherapy training, just as it is emphasized as paramount for physiotherapists as part of their professional development as clinicians (Dannapfel, Peolsson, & Nilsen, 2013). According to Sacket (1997), evidence-based practice (EBP) can be defined as:

The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients ... integrating clinical expertise with best available external clinical evidence from systematic research. (p. 3)

At first glance, this definition acknowledges the need to combine the use of experience-based and research-based knowledge in making clinical decisions in the best interests of each patient. In reality, however, a hierarchy of knowledge has come to dominate EBP - a hierarchy that privileges research-based knowledge stemming from randomized controlled trials (RCT) as opposed to experience-based knowledge (Wellard & Heggen, 2011). Indeed, proponents of such a hierarchy regard randomized controlled studies as in effect the gold standard in terms of what counts as best evidence (Dannapfel, Peolsson, & Nilsen, 2013; Engebretsen, Heggen, Wieringa, & Greenhalgh, 2016; Gibson & Martin, 2003). Thanks to a quantitative research design - in which participants are randomly assigned to either an experimental group or a control group - researchers can measure the effect of the intervention itself. In other words, by comparing pre-and post-test results of the two groups of participants, differences in "effect" can be ascribed to the intervention itself, rather than to the therapist or the patient (Ekeland, 2009; Standal, 2008, p. 203).

Originating from the field of medicine in the early 1990s, EBP increasingly came to be adopted by other health professions, including that of physiotherapy (Ekeland, 2009; Gibson & Martin, 2003; Sacket, 1997; Turner, 2001). Consequently, research-based knowledge stemming from randomized controlled trials increasingly came to shape clinical guidelines as well as debates concerning how to implement effective physiotherapy approaches in clinical practice. Proponents of EBP regard this pendulum shift away from clinical experience towards more emphasis on standardized procedures as paramount in legitimizing the physiotherapy profession, paving the way in terms of identifying and justifying effective interventions that will most benefit patients (Dannapfel, Peolsson, & Nilsen, 2013; Gibson & Martin, 2003; Turner, 2001). …

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