3 ms·

Do you therefore agree that most physicians do not "deep fund of literature-backed knowledge to draw from regarding exercise"? > Because there is so much varia

Do you therefore agree that most physicians do not "deep fund of literature-backed knowledge to draw from regarding exercise"? > Because there is so much variability in individual injuries and physiology it's extremely difficult to do rigorous studies comparing different treatments. This is generally true of research in all areas of medicine; I don't see it as a fundamental reason why we wouldn't hope for equally powered and rigorous studies focusing on the issues that affect most of the population, even if there are not pharmaceutical or device companies that will profit from the recommended interventions. I'm only a decade in, but my clinical experiences in my area of expertise vary widely from those of my colleagues, which vary from those of other colleagues, in spite of years of shared experience in a fairly homogenous demographic. Expert opinion is not a level of evidence that carries much weight in my mind. It may be the best we have in many cases, I just wish we had something better.

nradov 1y ago
It's a lot harder to do clinical research in some areas than others just due to the availability of subjects. Like if you're developing a new drug to treat type-2 diabetes then it's a lot easier and cheaper to identify patients who meet the inclusion criteria than to find patients with some particular type of shoulder injury or whatever. And the study endpoints are also problematic since there are no clear objective signs; usually they have to rely on patient reported symptoms. Some specialist physicians have a deep knowledge of exercise for injury prevention and rehab. But it also helps to get input from a good physical therapist and/or personal trainer. As a patient it can be tough to discriminate the good ones from the quacks.
- n8henrie 1y ago
  I don't think "easier" and "cheaper" are valid barriers to research regarding the most prevalent maladies affecting most people of the species. If there is a low morbidity gold standard for in-vivo diagnosis, it seems like a valid inclusion criteria. If there is no such gold standard available, it's kind of hard to validate a claim of someone having deep expertise. The endpoints for such research don't have to be problematic; regarding musculoskeletal complaints it's fairly straightforward to measure self-reported pain, self-reported level of function, or more objective measures like working days lost, strength, stamina, range of motion. The more difficult issue is determining an appropriate control group / placebo intervention. (Also, I'll point out that my initial comment also included nutrition, dentistry, and several other fields under the same umbrella of "not enough good research" -- or to further specify, my complaint is that the burden of disease is disproportionate to the availability of rigorous literature.) > Some specialist physicians have a deep knowledge of exercise for injury prevention and rehab. By what measure? As in "they have a lot of clinical experience" -- (the "plural of anecdote")? Or as in they have read a lot of books on the subject? In which case, you seem to be agreeing that the evidence base is weak, so I'm not sure how authoritative this body of literature could be. > As a patient it can be tough to discriminate the good ones from the quacks. I imagine they would be virtually indistinguishable as a patient. Based on the context of this conversation, how would you recommend that I, as a physician, tell them apart? (It's hard enough to do with other physicians.)

nradov 1y ago

It's a lot harder to do clinical research in some areas than others just due to the availability of subjects. Like if you're developing a new drug to treat type-2 diabetes then it's a lot easier and cheaper to identify patients who meet the inclusion criteria than to find patients with some particular type of shoulder injury or whatever. And the study endpoints are also problematic since there are no clear objective signs; usually they have to rely on patient reported symptoms. Some specialist physicians have a deep knowledge of exercise for injury prevention and rehab. But it also helps to get input from a good physical therapist and/or personal trainer. As a patient it can be tough to discriminate the good ones from the quacks.

n8henrie 1y ago
I don't think "easier" and "cheaper" are valid barriers to research regarding the most prevalent maladies affecting most people of the species. If there is a low morbidity gold standard for in-vivo diagnosis, it seems like a valid inclusion criteria. If there is no such gold standard available, it's kind of hard to validate a claim of someone having deep expertise. The endpoints for such research don't have to be problematic; regarding musculoskeletal complaints it's fairly straightforward to measure self-reported pain, self-reported level of function, or more objective measures like working days lost, strength, stamina, range of motion. The more difficult issue is determining an appropriate control group / placebo intervention. (Also, I'll point out that my initial comment also included nutrition, dentistry, and several other fields under the same umbrella of "not enough good research" -- or to further specify, my complaint is that the burden of disease is disproportionate to the availability of rigorous literature.) > Some specialist physicians have a deep knowledge of exercise for injury prevention and rehab. By what measure? As in "they have a lot of clinical experience" -- (the "plural of anecdote")? Or as in they have read a lot of books on the subject? In which case, you seem to be agreeing that the evidence base is weak, so I'm not sure how authoritative this body of literature could be. > As a patient it can be tough to discriminate the good ones from the quacks. I imagine they would be virtually indistinguishable as a patient. Based on the context of this conversation, how would you recommend that I, as a physician, tell them apart? (It's hard enough to do with other physicians.)