That’s a fact…
Recently, I was told that course content and discussion should be solely factual, and that opinion should not be used as it may bias discussion…
The fact is… much of what we know about pain and manual therapy is not necessarily fact but rather evolving hypotheses. It is the discussion that allows us to question and challenge our beliefs and it is our opinion that can promote healthy discussion. Using the best available evidence allows us to form better opinions.
If research has taught us anything, it is that research is always evolving and what we know and understand now, is very likely to look different in 10 years. Take pain research for example… In the last 10 years, almost half a million articles relating to pain have been published… But do we have all the facts?
Do not mistake research for fact, nor opinion for fact. Both are prone to bias, but this is a bidirectional relationship, with a broad understanding of the literature we can build better opinions, and it is these opinions that help to form hypotheses, and it is also these hypotheses that form research questions that can be tested. The opinions that we generate are the product of numerous sources of information and these opinions influence how we practice.
Research is dependent on numerous variables including study design, methodology, population etc. Is it a fact that exercise reduces pain?
Is it a fact that manual therapy reduces pain? Is it a fact that education reduces pain?
The only fact here, based on evidence, is that we don’t really know. You may have an opinion on what ‘works best’ but that is based on your knowledge, experience, personal bias, and opinion.
Research becomes more factual when using validated, reliable, and reproducible methods on different study populations. This forms higher quality research. Using high quality sources of information should then strongly inform our opinion and clinical decision making. If we combine that with clinical experience and context, all health practitioners should be on the same page when it comes to musculoskeletal pain, right?
3 clinicians walk into a room, A Chiro, a Physio and and a GP – Do they all come up with the exact same diagnosis and intervention?
Consider this… In the absence of opinion how would you come up with a working diagnosis? A working diagnosis is just that… it is an opinion, based on all available information. This is a picture you paint with every single patient. But you cannot call a working diagnosis fact but that doesn’t mean that it’s not important.
Do opinions matter?
Opinions allow us to challenge ideas, biases, and beliefs. Opinions should change considering new research and clinical experience.
If you take 10 experienced experts and ask them the same question relating to diagnosis in clinical practice when provided with the same information, there is a high probability that each of the 10 experts will have a different opinion based on the exact same information. Take the DOHA agreement meeting on terminology and definitions on groin pain for example. (Weir et al., 2015) Check it out here ➡️ PMID: 26031643.
Why is that important?
Opinions promote discussion, opinions allow us to question ideas and challenge beliefs, myths, and misconception. Discussion allows us to critique opinions and explore bias. Discussion allows us to come up with more questions. Discussion allows us to put knowledge into context and assists in the translation of scientific research into clinical practice. We all have strong opinions and bias, and we may not like it when another opinion goes against what we believe, but the important question we should ask of each other is “are you open to having your own opinion and bias challenged when presented with a different view?” That’s why discussion is important, that’s why opinions are important and that’s why evidence is important. To use one without the other would be like eating a sandwich with no filling.
Have an opinion but please allow that opinion to changed when presented with better information.
Thank you for reading my opinion!
