What kind of evidence are we looking for in aquatic therapy?

My main interest in this blog is alternative aquatics, which I have defined as any water-based healing modality that involves movement and/or bodywork but that is not considered suitable without significant modification for clinical settings or medical billing.

These kinds of practices may be found as part of spa-leisure and alternative health services, and are concerned with preventing ill-health and maintaining good health. Sometimes, though, people suffering from chronic problems that have not been helped by medicine do find help from alternatives.

There are many questions to be asked about this regards people made vulnerable by desperation in dealing with a health issue.  Whether the alternative approaches are safe is paramount.  Whether they are effective is also relevent, though the methods science uses to assess these may not be ideal.

In this post, I take a look at the evidence dilemma as it affects conventional medical practices.  Contrary to what many believe, the situation is not any more certain or reliable for some clinical treatments than it is for alternative healing methods.

For people needing treatment for serious acute and chronic health issues the issues are different than for those who are seeking preventive or maintenance health care, and those who are looking for enhanced well-being.

Aquatic physical therapists and other aquatics staff working in clinic situations are concerned with the first group. In the current US social and medical climate, cost and effectiveness are inseparable for this injured or unwell population.  The situation is further complicated by malpractice issues.

In the  July&August 2008 issue of AARP Magazine, Shannon Brownlee asked 'Why does Health Care cost so much?' (pp. 50-57) and put forward some ideas for possible medical health care reforms and their pros and cons in the US.  Brownlee noted that:

'Nearly a half-million [American] people file for bankruptcy every year because of high medical costs.  Another 47 million lack health insurance altogether.'

'[T]he most significant reason Americans are drowning in health care debt may shock you: Americans are getting far too much unnecessary care ...[and] new evidence suggest that too much health care may actually be killing us.'

(Under Obama's new administration the urgent need for reform is recognized and right now is in challenging process.)

In her article, Shannon Brownlee also discussed evidence-based medicine:

The prestigious Institute of Medicine recently published a report that estimates that only about half of what doctors do today is backed up by valid, scientific evidence.  The rest?  Many procedures and tests are based on medical tradition or on unproven and potentially faulty assumptions about how the body works.

Evidence-based research.  It is essential that we gather better scientific evidence for what works in medicine, what doesn't, and for which patients - and get the word out to doctors.  Take the example of spinal fusion to treat acute back pain.  We spend more than $16 billion each year on spinal fusions, even though there has never been a rigorous government-funded clinical trial showing that the surgery is superior to other methods of relieving back pain.

All this seems quite reasonable until you ask what kind of 'evidence' you need, how that 'evidence' is arrived at, and what you will use the information for.  Here are some questions that arose for me:

• Can enough scientific research be done? 

• Will that research provide the evidence that is needed to help people?

• Will this have any effect on treatment success?

• What can be offered to people who need help now?

It is arguable that we might get deeper and more lasting value -  for some issues at least - by looking more closely at the subjective elements of health care - from an individual's life choices, to the person by whom, and context in which, they are given help.

This is something I'll be addressing as part of a discussion on the value of documenting alternative aquatics, in Chicago at ATRI's Aquatic Healthcare Conference, 19-22 Nov. 2009.  I'm hoping to encourage dialog between medical and alternative aquatics practitioners regards the ways in which both could better serve those in need. 

We need more critical (but not defensive) discussion.  In future posts, I'll continue to write about how and why it's going to be valuable to do this.  We also need to listen far more to those who are suffering and seeking help through aquatic therapies - see for example this recent post: Feedback after aquatic bodywork: pain.

See also this post on Alternative Aquatics Research
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