My physical therapist gave me strengthening exercises for my knee arthritis. I’ve tried that kind of thing before and never really like it. What do you think?
The question above was posed to me by a client a few months ago. I was curious what the literature had to say. In about 10 minutes we found a pretty good answer.
10 Steps to quick literature searches.
- Understand the goal: The goal is to get a quick sense of the research consensus, not a deep understanding of a topic and not the most cutting edge developments. Not all questions will lend themselves to this kind of search, but many will. Clinical questions like “what relieves pain?” or “what reduces swelling?” are much easier to answer than questions about mechanisms such as as “what does stretching do to your muscles physically?” or “how does executive inhibition work?”
- Use google scholar or pubmed. www.scholar.google.com, www.pubmed.com. Google scholar and Pubmed are sophisticated search engine used by scientists and nonscientists alike to find the latest research on any topic. They are free. They are easy to use. They are great. (note: pubmed describes itself as covering medical and life sciences only)
- Learn what a “good” scientific journal is. The basic qualifications are:
- It is peer reviewed. I.e. the journal sends submissions to other top scientists in the field for review before publication.
- It is well respected by experts in the field. Here, for example, is a list of the top physical therapy journals http://www.scimagojr.com/journalrank.php?category=3612
- It is not “alternative”. A really good study of the effects of Tai Chi, for example, will end up in a good medical journal rather than a journal specifically devoted to alternative methods, dance, etc.
- Use review articles, meta-analyses or systematic reviews. Review articles and meta-analyses give an overview on well studied topics.
- A review article is an overview of the research on a topic written by one or more top experts in a field. It gives a well informed, objective picture of the state of the art. The author may also use quantitative techniques to analyse the research in which case the article may be called a “systematic review”.
- Meta-analyses are statistical techniques used to analyze the research that has been done on a topic. They give a systematic, unbiased overview of the results of lots of experiments.
- If you can’t find a review or meta-analysis, give up. Without a review article you would need to invest quite a bit of time and talk directly to a few experts to get to know a topic. Furthermore if no reviews for your topic exist, it may not have been thoroughly researched yet.
- Get an article published in the last 10 years or so. This rule applies particularly to clinical reviews, because therapies and health care changes so quickly. If the article is more than 10 years old, it can still be useful, but you may be missing out on recent developments.
- Choose good search terms. For the example above, I chose: arthritis knee strengthening exercises review. I combined the condition (arthritis), the treatment (strengthening exercises), and the word “review” to see if I could get a review article on the topic. I immediately got the following article “Aerobic walking or strengthening exercise for osteoarthritis of the knee? A systematic review” published in 2005 in the British Medical Journal. ( http://ard.bmj.com/content/64/4/544 ) I know that BMJ is a very good peer reviewed journal so I was set. The article is slightly more than 10 years old, so I ideally need to go back and search some more for a more recent update.
- Read the abstract. In review articles reading the abstract is often enough. You might need to read the text if there is something in the abstract is unclear, but often not. Also you can’t always get the full article – I seem to find the full article about 50% of the time.
- Use wikipedia. Wikipedia is an excellent place to looks up terminology or general topics that you don’t understand. For example, if you don’t know what arthritis is, start with Wikipedia.
- Present the article, not your opinion, and remember you are not an expert. When you are finished and want to discuss with your client, show them the article and explain as best you can why it could or could not be trusted. Let them judge themselves. Tell them to refer back to a specialist, perhaps with article in hand. In the end, you are not an expert. But that doesn’t mean you can’t provide some great information for yourself and your clients.
Try it and let us know what works and what doesn’t. And by the way, if you want to know the answer that my client and I found, check out the BMJ article.