“As part of the validation of this EU, I chose to participate to the conference of Dr Chad COOK, dealing with the subject of orthopedic tests, on Tuesday October 24th, 2017. This event was organized by EBP agency.
The participants in this conference were primarily physiotherapists, but there were also some students.
The theme of the evening was « orthopedic tests: how are they created, do they really help us and why are our “special” tests so bad? »
Dr. Cook’s presentation was divided into three main parts :
- The first part was to make us understand that less care produces better results « Less care may be better care ».Indeed, a multiplication of treatments would produce over-medication, which would have a detrimental effect on the patient’s condition. To demonstrate his argument, Chad Cook took as an example the case of low back pain. He explained to us that imaging tests are commonplace in the United States for this kind of pathology while the results do not bring anything. It is therefore better to wait and do nothing, because the cost is very high, for inconclusive results. By passing this type of examination, the patient tends to believe that his pathology is more serious than it actually is, which influences its recovery.
- Through the second part, he explained to us that, to have a clear communication between professionals and thus to obtain reliable diagnoses and good predictions, it is necessary to have the same references and the same language « A common diagnostic stand ». There are thousands of different diagnoses that may be wrong. It is therefore necessary to standardize criteria and build on the WHO references.
- Finally, he concluded that the results of some tests do not influence the value of the diagnosis, even if they are used every day by the physiotherapists community « Understanding the decision making capacity of tests ». A test has value only if it includes or excludes a pathology. Practitioners are led to make the right decisions despite bad tests that can lead to false positives or false negatives. Therefore some tests may be considered deleterious.
To conclude, I will say that this conference allowed me to realize the differences in practices that exist in different countries. And finally, that I learned that one must have a critical look at the tests used in the practice of physiotherapy even though they can be considered as standards. However, this was somewhat difficult at my sophomore level because I have not yet learned these tests.”