Indroduction to effective examination

Over the years many clinicians have commented about the increase in the need for what is described as Evi-dence Based Practice or Evidenced Based Medicine. The users' guides to evidence-based medicine (Journal of the American Medical Association, 1992) states that;

■ The understanding of basic mechanisms of disease are not sufficient guides for clinical practice alone.

■ Systematically recorded observations and repro-ducible measurements are needed to study the effectiveness of clinical practice. Two of the challenges in clinical practice are, the reproducibility of measurements of effectiveness and the clinical relevance of the measures made.

Two questions that have become commonplace in clinical research in the last few years are:

■ What are Minimal Clinical Important Differ-ences (MCIDs)? These can be defined as smallest measureable differences between the patient and a defined "normal".

■ What are Minimal Clinically Important Changes (MCICs)? These can be defined as the small-est change in score in the domain of interest due to a treatment which patients perceive as beneficial.

So the questions that need to be asked of biomechanics are:

■ Can biomechanics offer new and sensitive measures of assessment?

■ Can biomechanics assess the effectiveness of different treatments?

■ Can biomechanics offer immediate, informed and direct feedback to clinical practice?