There is a pandemic of epic proportions in pain management and physiotherapy, which is a pandemic of dysrationalia.
Professor Stanovich coined the term dysrationalia. Keith E. Stanovich is a professor of human development and applied psychology at the University of Toronto. The term “dysrationalia” is analogous to “dyslexia”, “meaning the inability to think and behave rationally despite having adequate intelligence, to draw attention to a large domain of cognitive life that intelligence tests fail to assess”.
Professor Stanovich mentions that one of the causes of dysrationalia is that people tend to be cognitive misers. People take the easiest path when they try to solve a problem; sadly, this often leads to illogical and wrong solutions.
A typical debate scenario is like the one below.
A physiotherapist (who is confronted with research that goes against their preconceived beliefs):
“Clinical practice is too complex for research; research is also biased and typically wrong. If we only use research, we will always be behind the current best practical practice”.
The same Physiotherapist a bit later (who now wants to advise on what to do and what “works”):
“I have great clinical experience with using a combination of Myofascial release and Kinesio tape on this specific type of complex disease; this works wonders for my patients. We should all use this Multimodal therapy intervention. I had a patient last week who now can walk again after two weeks of treatment.”
The above text is an excellent example of the typical double standard, non-critical thinking, and dysrationalia that are so prevalent in pain management and physiotherapy.
On one side, the argument is that clinical practice is too complex for research. However, this complexity does not limit the clinician or therapist in their ability to make far-reaching conclusions about complex multifactorial diseases. The complexity does not limit the clinician or therapist’s ability to know what factors are causal and influence the disease and the “solution” to the patient’s problems; this is only from their subjective and potentially biased observations. This is not logical!
Either clinical practice is too complex for research and the clinician or therapist’s ability to make assumptions, or it is not! You can make a strong argument that this complexity is the reason why we as clinicians, need research. We can’t merely rely on our potential bias and non-objective observations.