Evidence Based Medicine Cuts Both Ways – But do we respond accordingly?

If the evidence says it doesn’t work – would you stop?

As part of my MSc in Psychology, which like most areas of study entailed a considerable amount of research, evidence gathering and critical analysis, I was asked to research Developmental Co-ordination Disorder (DCD), or as it is more commonly referred to, Dyspraxia.

What is DCD?

There are several names for this disorder, ranging from “clumsy child” through to Developmental Co-ordination Disorder (DCD), although all broadly agree that there are common features, the key physical characteristics of which include difficulties with gross and fine motor skills, acquiring new motor skills, organisation, balance, academic performance and handwriting. In line with treating these broad characteristics were a variety of different therapeutic approaches, from which I chose to look at a process-oriented approach called Sensory Integration Therapy.

Sensory Integration Theory (SIT)

SIT hypothesises that there is impairment in the neurological processes that allow the brain to receive, register, modulate, organise and interpret sensory information.

The dysfunction in sensory integration explains why children with DCD have difficulties in learning skills, organisation, attention, participation in daily activities and social experiences. Sensory Integration Therapy is directly based on SIT and aims to provide various sensory experiences using adaptive responses to challenge the use of sensory input predominantly through play.


So far so good.

This seems a logical hypothesis…

  • There is a theoretical base for explaining how the underlying neurological deficit manifests in the key characteristics of DCD.

  • There is a therapeutic invention, which is offered by specialist practitioners and trained occupational therapists, where a significant percentage use it as a primary intervention, supported by the theoretical base.

  • There is a substantial evidence base, including an international review by The European Academy for Childhood Disability (EACD) in 2012.

  • Not least, there are over 40 years of practice to draw from, on working with children diagnosed with DCD by a range of practitioners that has filtered into practical, skills-based adjustments in homes and school classrooms across the world.

“There’s only one problem…the evidence base demonstrates that it doesn’t work!”

Despite this, it is still used. It consumes time, energy and financial resources, when evidence shows that it is entirely ineffective.

Research rules!

This illustrates that even when research and evidence is collated and produced, there is no guarantee that this will result in a change of practice and appropriate utilisation.

If we want to be effective and efficient then we need to be responsible for ensuring all services have a good-quality and rigorously-produced evidence base, which results in interventions that can be shown to be effective both therapeutically and in terms of cost.

Evidence is a powerful tool and should be the mechanism for the best and boldest of changes in practice and this includes discontinuing interventions when the evidence dictates it.

Do we just need to be braver in saying ‘we tried, it didn’t work, but we don’t yet know what will’?

There will of course be difficult conversations with families, but it could help us to free up the resources to research new, effective, interventions.

This is the kind of work that the Clarity team relishes working with our clients on, addressing not only procedures of limited clinical value, but really getting under the skin of the evidence base and outcomes to get the most from our health and care systems and ensure effective treatment options for people.

References

1 Chambers, M.E., Sugden, D.A., & Sinani, C. (2005). The nature of children with developmental coordination disorder. In D.A. Sugden & M.E. Chambers (Eds.), Children with developmental coordination disorder. London: Whurr Publishers Ltd.

2 Ayres, A. J. (1972). Sensory integration and learning disorders. Los Angeles, CA: Western Psychological Services.

3 Pollock, N.A. (2009). Sensory integration: A review of the current state of the evidence. Occupational Therapy Now, 11(5), 6-10.

4 European Academy for Childhood Disability (EACD) (2012). Recommendations on the definition, diagnosis and intervention of developmental coordination disorder (long version). Developmental Medicine & Child Neurology, 54, 54–93.




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