I’ve been wondering lately whether physiotherapy should be classed as quackery, in the same class as chiropractic. So came up with an idea for a double blind (?) study. Then realised that the same technique could be used as a double-blind (?) test for the success of modern education in general.

I’ve been thinking for a year or so that physiotherapy is a lot of pain with no positive outcome, much like acupuncture. A difference being that the pain in acupuncture is voluntary whereas that in physiotherapy is involuntary, like torture. A patient would report improvement of their condition to the physiotherapist in order to escape from the torture as much as possible even when any improvement has nothing to do with the procedure.

I looked up “double blind physiotherapy” on the web and the first hit was this.

“METHODS:
Randomised, double blind, placebo controlled trial; 140 community volunteers with knee osteoarthritis participated and 119 completed the trial. Physiotherapy and placebo interventions were applied by 10 physiotherapists in private practices for 12 weeks. Physiotherapy included exercise, massage, taping, and mobilisation, followed by 12 weeks of self management. Placebo was sham ultrasound and light application of a non-therapeutic gel, followed by no treatment. Primary outcomes were pain measured by visual analogue scale and patient global change.”

To my way of thinking, the above is not even single blind, the patient knows whether or not they are receiving physiotherapy – so it’s not blind for the patient, and the physician knows that they are giving physiotherapy – so it’s not blind for the physician.

I think a better double blind experiment is the following. Start with n physiotherapists and n patients, with n even. Advertise for n healthy actors to play the part of patients, and school them in the symptoms of their supposed condition. Advertise for n people who know nothing about physiotherapy to play the part of physiotherapists, and get them to sign a declaration that they will not attempt to learn about physiotherapy during the experiment. Split (using a balance based on age, sex, weight and ethnicity) to give the physiotherapists a 50% chance of getting a real patient and the patients a 50% chance of getting a real physiotherapist. Have sessions half-weekly for 3 months or weekly for 6 months. Each (real and sham) patient and physiotherapist writes a report on each session, with neither being aware that the other is writing a report. At the end a qualified doctor with minimal knowledge of physiotherapy and who is unaware that half the physiotherapists and patients are actors, uses the reports to assess improvement.

This is much closer to double blind, neither the patient or physician knows whether it was a genuine physiotherapy session. Perhaps triple blind because the assessor doesn’t know either. After all this is over, it is vital to get feedback on how much of the duplicity was guessed by each of the three groups to assess how blind this really was.

Then it occurred to me that this same method could be used to single-blind assess the success of formal education in other fields as well, such as in civil engineering (winks to Rev), architecture, teaching, social work, economics, etc. Set 50% uneducated and 50% formally educated people the same task (preferably a non-deadly one) to see how the end results compare.

>>>I’ve been wondering lately whether physiotherapy should be classed as quackery, in the same class as chiropractic.<<<

you should be ashamed of yourself, even for putting the two in the same sentence

The trouble is, the underlying assumption that a double blind test is the only test with any validity for medical practices is misguided.

What is important in any medical treatment is maximising the benefit and minimising the risk and the cost, and when you can’t do all three at the same time, finding the optimum balance.

Treating a placebo as being equivalent to doing nothing will not give an optimum balance because in many cases a placebo will provide a real benefit at minimal risk and cost.

If you have a treatment that provides real benefits as well as placebo benefits (such as both physio and chiropractic treatments) then to set up the research to hide the placebo benefit is guaranteed to generate a non-optimum result.

Where “real benefits” = benefits based on real physical mechanisms, rather than real psychological mechanisms.

As for civil engineering, you might like a look at this video showing testing of the shear strength of a very large reinforced concrete beam, compared with prior predictions from a large number of academic and industry engineers.

https://www.youtube.com/watch?v=bukiQWx3E4I

The video is made by the winners, so of course their predictions were just wonderful, but have a look at the graphs showing the scatter of the predictions at about 1 min 30.

The Rev Dodgson said:

As for civil engineering, you might like a look at this video showing testing of the shear strength of a very large reinforced concrete beam, compared with prior predictions from a large number of academic and industry engineers.

https://www.youtube.com/watch?v=bukiQWx3E4I

The video is made by the winners, so of course their predictions were just wonderful, but have a look at the graphs showing the scatter of the predictions at about 1 min 30.

So do you use Atena software, Rev?

they could get me to teach politics at night school

sibeen said:

The Rev Dodgson said:

As for civil engineering, you might like a look at this video showing testing of the shear strength of a very large reinforced concrete beam, compared with prior predictions from a large number of academic and industry engineers.

https://www.youtube.com/watch?v=bukiQWx3E4I

The video is made by the winners, so of course their predictions were just wonderful, but have a look at the graphs showing the scatter of the predictions at about 1 min 30.

So do you use Atena software, Rev?

No, can’t afford it.

But the numbers you put in are more important than the software anywy.