A friend sent me the questions of the just concluded TN MRB exam question. By the way kudos for having a great memory to list down the 100 question.
This question caught my attention.
"SWD is best (effective) in:
Degenerative joint conditions
Capsular lesions in large joints
Tenosynovitis
Moderate edema"
This question intrigued me, and here's why.
Let’s start by examining the word "best." We use this term frequently in everyday life—calling someone our "best friend" or declaring something as the "best biryani." But what do we really mean by "best"? In the context of biryani, it implies that out of all the biryanis you've tasted, this one stands out as the most enjoyable. When it comes to a "best friend," the meaning becomes more abstract and subjective.
When it comes to health care what does it mean this is the best treatment?
Now, applying this to healthcare, what does it mean to say a treatment is the "best"? How do we define "best" in this context? One possible definition could be: out of all the treatments available, this one produced the most favorable outcomes. However, this definition immediately raises two critical questions:
What are you comparing it to?
How many times and in how many patients was this comparison made?
Additionally, what do we mean by "result"? To evaluate a treatment's effectiveness, we need specific endpoints, such as pain reduction, improved mobility, or decreased disability. For example, saying "Usain Bolt is the best" is meaningful only when
qualified—best at what? In his case, it's the 100-meter sprint. Similarly, SWD ) being "best" needs clarification—best at reducing pain, improving joint function, or addressing inflammation?
This question, as it stands, is highly colloquial and vague. One reason for such phrasing is the gap in communicating scientific concepts with precision. The same thing i have noted when PTs put educational videos with title like, the best exercise you need to do if you have OA knee, you are a runner, LBP or if you cut your hair, we often struggle to articulate ideas with scientific rigor. This lack of precision can lead to ambiguity, especially in exams or professional discussions, where clarity is paramount.
What the duck is wrong with us?
Pain is typically classified based on:
Duration (acute vs. chronic),
Origin (neuropathic, somatic, visceral, etc.),
Characteristics (referred pain, radiating pain, phantom pain, etc.).
There’s no scientific basis for classifying pain based on the answer options provided in this question. The effectiveness of SWD (Shortwave Diathermy) is determined by its application to specific conditions, not by grouping unrelated conditions like degenerative joint conditions, capsular lesions, tenosynovitis, or moderate edema. These are distinct conditions with different underlying mechanisms, and SWD’s effectiveness isn’t tied to such a broad or arbitrary classification.
Including moderate edema as an option is particularly puzzling, as edema is a symptom rather than a specific condition, and its treatment approach differs significantly from the others listed. Moreover, there’s a lack of systematic reviews (SR) or robust evidence to conclusively say that SWD works for any of these conditions, let alone for such a random grouping.
Parting words: Leave adjectives like "best" to poets and romantic conversations with your partner. When it comes to science communication, tread carefully with non-quantifiable terms. Precision and clarity are the cornerstones of scientific discourse, so opt for measurable, evidence-based language to avoid ambiguity and ensure meaningful understanding. Science thrives on specificity, not subjectivity.
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