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  • Doug Nelson

Uncertainty

Not long ago, I was listening to my friend Karen speak about evaluating outreach programs and how data can be a valuable asset in that endeavor. "The point of gathering data," she said, "is to reduce uncertainty."


It always surprises me how a simple statement, for whatever reason, resonates deeply upon hearing it. Such was the case with her statement about uncertainty. Karen did not say the point is to eliminate uncertainty, only to reduce it. In so many ways and in so many applications, this is an important point.


In the world of research, one can never be absolutely certain of any finding. That is why you read statements like, "the evidence supports the idea that..." rather than ever using the word "prove". We, as a culture, love the idea of certainties and absolutes and often get frustrated with the world of science that seems ambiguous. This is often why my scientist friends are very reticent to give interviews with the press for fear that their initial findings get turned into a much more absolute than their research actually suggested. There is never supposed to be an absolute agreement in any question. Even if 97 of 100 studies point in one direction, there are going to be those three that point to the opposite conclusion. This is as it should be.


As a clinician, much of my time is also spent reducing, but never eliminating uncertainty. The reason for every assessment I undertake is to, within reason, narrow down possible causes for my client's discomfort and therefore clarify an appropriate response. Any of these assessments, taken individually, have questionable validity. Range of motion testing, orthopedic testing, structural imbalances, resistive testing, tissue texture, etc, all of these can be, and often are, questioned for their validity. En masse, however, they help me clarify a course of action and thus be more effective. How is effectiveness measured? For those of us spending our days seeing clients, the benchmark of effectiveness is clinical outcomes. Is the client's experience of pain substantially less? Are they able to return to their previous level of activity? Success is determined by their experience.

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