1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899 EVIDENCE-BASED MANUAL MEDICINE: A PROBLEM-ORIENTED APPROACH Copyright © 2007 by Saunders, an imprint of Elsevier Inc. ISBN-13: 978-1-4160-2384-5 All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Permissions may be sought directly from Elsevier’s Health Sciences Rights Department in Philadelphia, PA, USA: phone: (+1) 215 239 3804, fax: (+1) 215 239 3805, e-mail:
[email protected] You may also complete your request on-line via the Elsevier homepage (http://www.elsevier.com), by selecting ‘Customer Support’ and then ‘Obtaining Permissions’. Notice Knowledge and best practice in this field are constantly changing. As new research and experience broaden our knowledge, changes in practice, treatment, and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on their own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the Authors assume any liability for any injury and/or damage to persons or property arising out of or related to any use of the material contained in this book. The Publisher Library of Congress Cataloging-in-Publication Data Seffinger, Michael A. Evidence-based manual medicine : a problem-oriented approach/Michael A. Seffinger, Raymond J. Hruby; illustrator, William A. Kuchera. – 1st ed. p. ; cm. Includes bibliographical references and index. ISBN 978-1-4160-2384-5 1. Evidence-based medicine–Handbooks, manuals, etc. 2. Musculoskeletal system–Diseases–Handbooks, manuals, etc. I. Hruby, Raymond J. II. Title. [DNLM: 1. Musculoskeletal Diseases—therapy. 2. Evidence-Based Medicine–methods. 3. Manipulation, Orthopedic–methods. 4. Pain–therapy. 5. Sprains and Strains–therapy. WE 140 S453e 2007] RC55.S426 2007 616–dc22 Acquisitions Editor: Rolla Couchman Project Manager: Bryan Hayward Design Director: Steve Stave Printed in United States of America Last digit is the print number: 9 8 7 6 5 4 3 2 1 2007004481 Foreword Professional organizations, government agencies, insurance companies, and the general public now demand that clinical decision making by health care providers should rely as much as possible on evidence that has been derived from research. The comprehensive approach to clinical problem-solving and therapeutic planning set forth in this book offers physical/manual medicine practitioners therapeutic choices based on, or that are informed by, evidence. The description of detailed approaches to clinical problem solving is a major feature of this book. This feature provides physical/manual medicine practitioners with an excellent resource to meet standards requiring evidence-informed reasoning and planning. The therapeutic decision-making processes necessary to meet these requirements may involve overcoming a number of obstacles, such as evaluating apparently conflicting evidence and judging the efficacy of long-used procedures of assessment and treatment. For the health care provider, the old adage that “lack of evidence of efficacy does not equal evidence of lack of