Author Archives: Craig Payne

Craig Payne

About Craig Payne

University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger, dad. Follow me on Twitter, Facebook and Google+

How does stuff like this make it into professional journals?

Any publication with the title of A Novel Treatment Approach to Over-Pronation Dysfunction is going to get my attention, mostly because of the nonsensical understanding of “overpronation”. I was not disappointed and it was as bad as I expected.

Even before I got the full paper, just reading bits like this in the preview: “The literature supports a forefoot varus as the most frequent cause of over-pronation compensation. 1,2“. The two cited references did not show that and one was him quoting himself saying that. The alarm bells start going off about a lack of academic rigour and lack of critical thinking skills. A true forefoot varus (based on the textbook definition) is actually quite rare and far from being a common casue of “overpronation”.

On reviewing the full paper, the author proposes a new treatment for forefoot varus (which he has a patent on), when they don’t even know what forefoot varus really is! The author is confusing the theoretical constructs of ‘forefoot varus’ and ‘forefoot supinatus’ and really has no clue how foot orthotics even work in those two different constructs. There is certainly a lack of critical thinking skills and academic rigour in what is being written by the author (not to mentioned the editorial and peer review processes that allowed it to be published). I have written many times before (eg) about this confusion between the two and the chicken and egg situation with research that is done on one or the other or both.

I went onto great detail on the difference between the theoretical constructs of forefoot varus and forefoot supinatus here. Both present as an inverted forefoot when the lateral column is loaded and the rearfoot about neutral. Basically, the construct of forefoot varus is that it is osseous, rare, not correctable and is a cause of “overpronation”; whereas the construct of forefoot supinatus is that it is a soft tissue contracture, common, is correctable, but is the result of “overpronation”.

A simple cursory read of the paper shows that the author had no idea about forefoot supinatus (and does not even mention it) and ascribes some of the characteristics of forefoot supinatus to confuse it with what he thinks is a forefoot varus (its not). As a forefoot supinatus is a soft tissue contracture, then what he proposes can be helpful, is not new and is not novel and has been like a number of strategies that have been used for a forefoot supinatus over the years. The nature of what he is proposing will facilitate the stretching out of the soft tissue contracture as have mobilisation techniques been doing that for years. So too has the nature of the short foot exercise been restoring the “arch height” of those with a forefoot supinatus. However, all those techniques, including the one proposed by the author, will fail in a forefoot varus as it is a bony or osseous issue.

The problem with a forefoot supinatus is something is causing it. This is not acknowledged by the author, let alone understood by him. The approach advocated by the author is destined to fail in the long term unless that cause is removed. Short terms gains in arch height could be expected with what he is proposing.

The author then justifies his approach by applying the “it worked for me” logical fallacy. Seriously? In a professional journal?

At least the journal did include a response by Robert D. Phillips, DPM to what was published. My only criticism of what Daryl wrote is that he was too polite and should have ridiculed the concept.

I do acknowledge that there can be a difference of professional opinions, but in this case, this is not a case of professional opinion, but a confused superfical misunderstanding of the literature and a misunderstanding and misuse of concepts and terminology. It certainly lacks the academic rigour to be published in a professional journal.

On one hand, I am perplexed how something as confused as this can make it through the editorial and peer review process of a professional journal. On the other hand, we are talking about JAPMA who regularly publishes papers that are below an acceptable standard (see my posts here and here) and for some reason, republished the paper that was previously published in another journal (Journal of Orthopaedic Physical Therapy Practice) that from what I can tell does not even exist as a journal. There is a magazine by that name, but not a journal!

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Craig Payne

University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger, dad. Follow me on Twitter, Facebook and Google+

‘More junk getting through to the keeper*’

The whole idea of the peer review process prior to publication is to weed out the junk, so it does not get published. One thing that the alternative therapies have in common is that their journals let a lot of junk science through. Too many studies get published in those journals that should never see the light of day, let alone been conducted so badly in the first place. There are ethical issues at stake in this and the editors of those journals would do well to apprise themselves of publication ethics. Institutional ethics committees or review boards also have a responsibility to prevent bad science from even getting off the ground.

What spurred that little rant was this publication today on ‘The effect of reflexology on the quality of life with breast cancer patients‘ published in the journal, Complementary Therapies in Clinical Practice. They do not get much worse than this one.

It was a study that supposedly randomized 60 people with breast cancer into two groups; one group the control and one group getting reflexology; the aim being to see how it affected their quality of life and symptoms. Sounds good on the surface, but:

They ended up with exactly 30 in each group and reading what they did, they did not randomise – even though they said they did! They just allocated them to different groups depending on the day of the week. The assumption of the statistical tests used are that proper randomization is used. Epic Fail. How can the reviewers and editor not see that randomisation did not take place? Regardless of the results of the study, stop there as without proper randomisation the results are meaningless and can not be trusted. As the study was approved by the “Ethical Committee of the Health Science Institute¬†of Ataturk University”, then that ethics committee needs to look at its decision-making process, as all the work that went into this study and the voluntary participation of the participants was wasted.

I have already blogged about reflexology studies almost always ending up with the exact same number in each group when they are supposed to be randomised and this study just confirms that problem.

And while we could stop there as the data can not be trusted, they then went on and did 38 within groups t-tests! Seriously? DId the authors, peer reviewers and editor of the journal not see an alarm bell go of with that?

  • it was a within groups analysis rather than a between groups analysis
  • do that many t-tests, just by chance you will get a statistically significant result
  • no hints of a Bonferroni correction because of the multiple tests.

The author’s conclusion of¬†Reflexology was found to reduce the symptoms experienced by breast cancer patients, while at the same time increasing the functional and general health status simply can not be supported by the data from this study … yet it still made it through to the keeper.

Having said that, a damn good foot massage will probably make anyone with a chronic illness feel better; it is that, that is NOT reflexology and that is NOT supported by the results of this study.

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*for those not familiar with the metaphor: “through to the keeper”; it comes from cricket when the batsman does not even attempt to play at the ball and lets it pass through to the wicket keeper unchallenged.

 

Craig Payne

University lecturer, runner, cynic, researcher, skeptic, forum admin, woo basher, clinician, rabble-rouser, blogger, dad. Follow me on Twitter, Facebook and Google+