Example: Empirical observations vs. mechanistic understanding

The theme of the weekend is examples of the traps we fall into with strict adherence to empiricism in the manner which has dominated current understanding of EBP. This example starts from the release of an online first PTJ article (which I did enjoy reading and will use in my research methods class this upcoming semester). While I hold off on a critical analysis here as I consider a formal response as a letter to the editor, I just want to point out that this is a great example of empirical observations being considered as more important to clinical decision making than mechanistic understanding (a foundational assumption with EBP). Now it is implicit, not explicit. The authors may not believe that they are putting empirical observations as more important. But if they are true to the underlying philosophy of EBP then they probably do despite what a purely EBP perspective would say about their article.

The article identifies a correlation between VO2 peak and walking capacity in patients that have had a stroke (it is a systematic review, so it points to several articles that have demonstrated a relationship). Of course, mechanistically no one can deny that there would need to be some association between energy and work given their definitions. The article does not actually discuss the tacit causal assumptions of the data is reports. But my major issue is that it supposes that this correlation would have a bearing - at all - on the clinical decision to recommend aerobic conditioning in a post stroke rehabilitation program. If you are a therapist working today, and your patient demonstrates signs of an endurance impairment that seem to be associated with an aerobic limitation, please use aerobic conditioning as part of your treatment - regardless of what the pooled correlation coefficient is in this review. That recommendation is based on knowledge, that knowledge is based on prior empirical observations AND mechanistic reasoning.

You can find the article here

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