Methods, techniques and tools within (neuro)rehabilitation should be as reliable as e.g. surgical treatment or drug therapies. But contemporary evidence(s) in (neuro)rehabilitation and neurological physiotherapy are still weak. Most valuable (according to EBM and EBM rules) clinical trials and randomized controlled trials are rare and not always regarded as relevant. Value of detailed case reports is still underestimated. Where is the role of the researchers (facing EBM, EBP, necessity of clinical guidelines, supporting clinical decision making process)? Which direction of further research should we support: CTs/RCTs, case reports, both, or something else? Where is the evidence in contemporary (neuro)rehabilitation?
Your question is relevant to the whole field of “science”, not only rehabilitation. Basically, the medical model, nowadays, is subject to the diminat reductionist-determinsitic paradigm. “Truth” lies behind what is appearing (the “phenomenon”). What is appearing “the “whole” is the inevitable results of the “parts” behind. Whenver you have to do di with a whole person,like in clinical medicine ((rehabilitation is just a representative of this), you look less “scientific” than when you are looking at cells or molecule: you “skip over “ the deceptive appearance and you get closer to the “truth”.
This conception gave wonderful results during the latest two centuries (form antibiotics to surgery…) but is failing to face disability, aging, chronic disease, psychiatric illness…and in general the need for individual curing/caring. I’m using the metaphor of divorce between caring and curing, or between science and assistance.
And now? Don’t be depressed. Are there solutions? Yes, facing the problem on a scientific ground, without escaping towards a purely “humanitarian” approach (rehabilitation is for the “good guys”, genetics is the “clever scientists”).
How to implement technically this view?
All of your issues about “evidence”, trial designs etc. have a sound scientific response. I wrote something on this topic. May be you can start from there (see attachments).
RCT is the best study with level 1 to provide evidence. It can include quase-randomized study. II think it is important considert hat other kinds of study can be also relevant to improve practice.
Thank you both for such valuable contribution. I hope this issue will be discussed and developed in the future.
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