Evidence In Podiatry Practice: An Interview With The Run Research Junkie Himself – Craig Payne

Craig Payne likes to describe himself as a University lecturer, runner, cynic, researcher, sceptic, forum admin, woo basher, clinician, rabble-rouser, blogger and dad. He blogs at Run Research Junkie http://www.runresearchjunkie.com and It’s a Foot Captain, BuPayne_print.jpgt Not as You Know It http://www.itsafootcaptain.com/ ; is the admin at Podiatry Arena http://podiatryarena.com/index.php and runs the Clinical Biomechanics Boot Camps http://podiatrycpdacademy.com/clinical-biomechanics-boot-camp/ .

Simon Bartold recently stated in an online interview with Ted Jedynak that “just because the research isn’t there doesn’t mean we should be chucking out the therapy”. Do you agree with this statement and do you believe that modalities with limited research such as kinesiology taping and Foot Mobilization Techniques should be practiced without that research?

Of course I do, but you also have to be very careful making such statements as the promoters of pseudoscience and woo use the same logical fallacy. If you do not want to be tarred with the same brush as them, then you need to be careful how you phrase it. There is a lot more to it than just the strength of evidence for an intervention; there is also things like biological plausibility and theoretical coherence. It also must be consistent with the available evidence. If it is not theoretically coherent nor consistent with all the available evidence, then you need to modify the theory or model that underpins the intervention.

When writing a research article there is potential for many mistakes to occur, from analysis of data to misinformed or inappropriate data collection and the conclusions deducted from that data. Where do you believe most people tend to go wrong when developing and writing a research article?

The biggest issue that I have blogged about several times and called papers and jour
nal editors out several times on is the use of a within groups rather than a between groups analysis. It can lead to the wrong conclusion and has several times. That is not a minor issue, it is significant. I produced a video on it here: http://www.itsafootcaptain.com/within-group-vs-between-groups-analysis-of-trial-data-and-the-way-too-many-studies-get-it-wrong/

The other problem you see a bit of is the over-exaggerated claims that get made by authors (and University press release departments) for the importance of their results when there are issues in the study. The study may well have been good, but might have been done on,
for eg, healthy female undergraduate students – how representative are they of the total population or the population of interest to clinicians with problems?

Bias can occur in a number of ways when it comes to research including; pre-conceived ideas, a desire to achieve a specific outcome, commercial finding and conflict of interest. Do you feel these issues regularly affect the outcome of research and does it happen very often in that which effect podiatry as a profession?

I don’t. I am a bit different than many others on this one. Yes there are preconceived biases, commercial funding and conflicts of interest. I tend to be more trusting of the integrity of researchers than others (even though there are glaring examples of research fraud that are rare). For eg if there is a conflict of interest and/or commercial funding, but everything in the study was done with adequate blinding, then what is the problem? Where I do tend to see these as being a problem is the “tone” of writing or “spin” put on the results by the authors that may reflect the biases and vested interests, but that is why you focus on the actual study design and results and not necessarily the wrote up.

As patient management becomes more individualized do you believe there is potential to be a further disconnect between research and clinical relevance?
The opposite should be happening. What I see as an issue is the understanding by clinicians and researchers about the role that research plays in clinical practice and that is often misunderstood and misused. Life in general and clinical practice in particular is based on belief systems, model or theories – there is no escaping that. What matters is how consistent the belief system, model or theory that is used is with the body of evidence. If there is evidence that contradicts your belief system, model or theory then you need to either find a good compelling reason why that research is fatally flawed or move or adapt your belief systems, model or theory. Dismissing research that does not fit your belief systems, model or theory is fraught with danger. That is what those who promote junk, pseudoscience and woo do. We shouldn’t.

With Evidence Based Medicine being highly promoted within the medical and allied health industry, do you believe there is an increased risk of stepping on the toes of each other’s professions? How would this be best avoided?

To be honest I really don’t give a ‘f’’! All professions are trying to expand their scopes of practice to do work traditionally done by other professions while at the same time defending their professions from encroachments from attempts to extend the scope of other professions. This has been going on for as long as I have been around and the world still has not ended. You can’t have it both ways. We all in it for the patient and to make them better.

I often try not to necessarily identify myself as a “Podiatrist”, but often as a “Clinician” in the “foot orthotic industry”. I interact with, teach and learn from all the professions and players with a foot in the “foot orthotic industry”

Where do you see podiatry heading as a profession in the future? What will we have to defend against, where will we stand out and how will be portrayed on a world stage?

Just doing what we do well.
The biggest problem we are facing is the claims made in social media that patients read that are not supported by or even contradicted by the evidence. That is why I started my blog, to get the actual evidence based approached out there.
Jackson McCosker
Director/ Chief Editor

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