Evidence informed practice – research versus hypothesis

The papers below appeared during the covid pandemic, and relate to a discussion about the possible osteopathic interactions in covid.  There was a response criticising the Marin paper, and the criticism said (paraphrasing:) You can’t say those things, you are overstating what the source literature says, you are making too much from your literature, and so you are creating bias and misinformation and leading people astray.  However, in my view Draper Dod et al, were themselves over-reaching, and writing as though Marin had claimed more than they did.  This is its own form of bias.  I mention this as when discussing research and trying to explore the scientific rational for something (the first step in the research process), it is important to look forwards – as evidence that is already reported may not be responding to your line of enquiry, and accordingly will always fail to support your research query.

These papers relate to the above covid / osteopathy debate.

• Evidence-based assessment of potential therapeutic effects of adjunct osteopathic medicine for multidisciplinary care of acute and convalescent COVID-19 patients
• The importance of rigour in the reporting of evidence for osteopathic care in Covid-19 papers
• The importance of epistemological consideration in the reporting of evidence for osteopathic care in Covid-19 papers

To consider the background to exploring hypothesis and rationale, the following is useful:

• As stated by Draper-Rodi et al. in their concluding paragraph, “theorising about potential mechanisms, and formulating hypotheses are the foundations of scientific enquiry”.2 As all of the concerned authors are both clinicians and researchers, it seems opportune to recall the assertions of Archibald Cochrane, one of the fathers of modern evidence-based medicine13:
• ‘Rational scientific and methodological principles are not sufficient for securing rational and humane health care. A philosophy reminding us of both our limited scientific possibilities—limited in principle—and our personal responsibility is needed. It is one of Cochrane’s great merits to have provided just that. It is to be regretted that many more people seem to have adopted his more technical advice concerning effectiveness and efficiency than have grasped the philosophical framework within which these standards are situated’.
• The guidelines of the Osteopathic International Alliance are consistent with this rationale; our review was carried out accordingly. Clinical researchers have a bridging responsibility between the requirements of systematic and rigorous laboratory processes and the practical and human realities of patient care. Both fields are complementary and should lead to mutually beneficial progress. Albeit challenging, this dual role is essential for enabling both innovative research and advancing healthcare.

Strengthening case based research approaches:

• Systematic case study research: A practice-oriented introduction to building an evidence base for counselling and psychotherapy
• Historically, clinical case studies have played a central role in counselling and psychotherapy training and practice, by allowing practitioners to learn about ideas and interventions being developed by colleagues. In recent years, the development of methods for systematic collection and analysis of case data has made it possible for case study research to begin to make a contribution to the evidence base for therapy policy and practice.

A.T.Still was a very good primary observer, and his hypotheses are still waiting effecting research:

• Theory Building from Cases: Opportunities and Challenges
• A major reason for the popularity and relevance of theory building from case studies is that it is one of the best (if not the best) of the bridges from rich qualitative evidence to mainstream deductive research. Its emphasis on developing constructs, measures, and testable theoretical propositions makes inductive case research consistent with the emphasis on testable theory within mainstream deductive research. In fact, inductive and deductive logics are mirrors of one another, with inductive theory building from cases producing new theory from data and deductive theory testing

Osteopathic philosophy as a means to understanding pathogenesis of disorders:

• This is why osteopathy is a system of medicine not a biomechanical musculoskeletal adjunctive therapy.
• Its not about ‘cure’ its about contributing to the debate on what causes and what stops recovery of people from illness, sickness, disease, dysfunction, poor agency, biobehavioural compromise, lack of health…whatever is the right term!

How to proceed?

Considering underlying plausibility and
Scientific Rationale: here are some useful papers:

How to proceed when evidence-based practice is required but very little evidence available?

Distinguishing Scientific From Pseudoscientific Psychotherapies: Evaluating the Role of Theoretical Plausibility, With a Little Help From Reverend Bayes

But, as already stated: IF NO ONE HAS TESTED THE HYPOTHESIS YOU ARE INTERESTED IN THERE WON’T BE ANY EVIDENCE TO EXPLORE.

Further comments about how to proceed and to organise a therapeutic framework are found in the ‘evidence informed frameworks’ lesson.