Ethics and EBM in physiotherapy and in occupational therapy
While there is a plenitude of analyses of moral issues in medicine and biomedical sciences, there is much less on related fields as physiotherapy or occupational therapy. Obviously, most of moral principles for physicians applies also to physiotherapists and occupational therapists as well. However there are some specific differences between medical “main stream” and related sciences. Primo, physiotherapist and occupational therapist provide care to an exceptional kind of patient: to a person with disability. That makes the range of professional and moral obligations also exceptional. It is visibly clear with the use of ICF (International Classification of Functioning) in a complex definition of disability. Secundo, in physiotherapy and occupational therapy there is a slightly different kind of relationship between patient and therapist: it is much more profound and much more personal, what imposes specific moral obligations towards patients. Tertio, EBM (Evidence Based Medicine) has different meaning and different role in related fields. As EBM is a core of current medicine, it has to be re-defined for the use of physiotherapy and occupational therapy. Evidence Based Medicine (EBM) is characterized not only as a procedure of clinical reasoning but also as a system of hierarchy of scientific research and scientific publications. Then four classes of constraints of EBM are examined, based on philosophy and ethics, concerning Randomized Controlled Trials as golden standard of evidence and treating EBM as a kind of matrix of clinical reasoning. On such basis the place of EBM in physiotherapy and occupational therapy is being indicated. The main issue of the article is EBM in physiotherapy and occupational therapy, as it focuses all the differences of the first and of the second type. In the end, the coordination model is discussed as it ensured the career of EBM in physiotherapy and occupational therapy.
- 1. Beauchamp TL, Childress JF. Zasady etyki medycznej. Warszawa: Książka i Wiedza; 1996.
- 2. Ayres I. Super Crunchers: Why Thinking-By-Numbers is the New Way To Be Smart. Bantom; 2008.
- 3. Sacket DL, Rosenberg WM, Gray JA et al. Evidence Based Medicine: What it is and what it isn’t. Br Med J 1996; 312(7023): 712.
- 4. Cook DJ, Jaeschke R, Guyatt GH. Critical appraisal of therapeutic interventions in the intensive care unit: human monoclonal antibody treatment in sepsis. J Intensive Care Med 7 1992; (6): 275-82.[PubMed]
- 5. http://libraries.umdnj.edu/camlbweb/EBM/picomodel.htm (17.12.2012).
- 6. Balshem H, Helfand M, Schünemann HJ, et al. GRADE guidelines: Rating the quality of evidence". J Clin Epidemiol 2011; 64(4): 401-6.
- 7. http://www.who.int/classifications/icf/en/ (17.12.2012).
- 8. Vos R, Willems D, Houtepen R. Coordinating the norms and values of medical research, medical practice and patients worlds - the ethics of evidence based medicine in orphaned fields of medicine. J Med Ethics 2004; 30: 166-170.[PubMed]
- 9. Leeder SR, Rychetnik L. Ethics and evidence-based medicine. Med J Aust 2001; 175(3): 161-164.
- 10. Loevy EH. Ethics and Evidence-Based Medicine: Is There a Conflict? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2100103/ (17.12.2012).
- 11. Goodman NW. Ethics and Evidence-Based Medicine: Fallibility and Responsibility in Clinical Science. http://22.214.171.124/content/96/5/251.full (17.12.2012).