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âThe very first step towards success in any occupation is
to become interested in it.â
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—Sir William Osler (1849–1919)
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Until the beginning of the last century, knowledge about the
mechanism of healing and the methods to decrease pain and
suffering were extremely limited. Although we may scoff at
many of the interventions used in the distant past, many of
the interventions we use today, albeit less radical, have still to
demonstrate much more in the way of effectiveness. That may
soon change with the recent emphasis within many health-care
professions on evidence-based clinical practice. The process
of evidence-based practice is presented in Table I-1. When
combining clinical expertise with the best available external
clinical evidence, clinicians can make informed decisions
regarding patient management, including the selection and interpretation of the most appropriate evaluation procedures.
In addition, intervention strategies that are based on the best
available evidence will have a greater likelihood of success
with the least associated risk.1,2
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The goal of every clinician should be to enhance
patient/client satisfaction, increase efficiency, and decrease
unwarranted treatment approaches.2 The management of the
patient/client is a complex process involving an intricate
blend of experience, knowledge, and interpersonal skills.
Obtaining an accurate diagnosis requires a systematic and
logical approach. Such an approach should be eclectic,
because no single approach works all of the time. For any
intervention to be successful, accurate diagnosis must be
followed by a carefully planned and specific rehabilitation
program to both the affected area and its related structures. In
this book, great emphasis is placed on the appropriate use of
manual techniques and therapeutic exercise based on these
considerations. Electrotherapeutic and thermal/cryotherapeutic
modalities should be viewed as adjuncts to the rehabilitative
process. This book contains
numerous video clips of manual techniques and therapeutic
exercises, which the reader is encouraged to view. The
following icon is used throughout the text to indicate when
such clips are available. [VIDEO]
1. Sackett DL, Rosenberg WM, Gray JA, et al.: Evidence based medicine:
What it is and what it isnât.
BMJ 312:71, 1996.
[PubMed: 8555924]
2. Schroder JA: Manual therapy and neural mobilization: Our approach and
personal observations. Orthopaedic Pract 16:23, 2004.