Tag Archives: physiotherapy

Argument formation for academic writing

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Many students find it difficult to identify what it is that makes a good piece of academic writing. At the core of such writing is the nature and structure of the intellectual argument. Here is some information that we share with our Physiotherapy students at the University of Nottingham to help with their understanding of arguments. I hope you find it useful.

Argument formation

The idea of a basic argument is fairly simple. An argument is formed of ‘premises’ and ‘conclusions’. For a valid argument, in order for the conclusion to be true (which is what you want in an essay, i.e. you don’t want to draw false or unstable conclusions), the premises must be true. So, the classic example is:

Premise 1: All men are mortal

Premise 2: Socrates is a man

Conclusion: Socrates is mortal

Do you see that if P1 and P2 are true, then the conclusion HAS to be true?

So, if it REALLY IS true that all men are mortal, and it REALLY IS true that Socrates is indeed a man, then it HAS TO BE THE CASE that Socrates is mortal. Yes? Do you get that?

Make sure you fully understand this basic principle before reading any further!

OK, so let’s look at another example:

P1: Lucy is a physio

P2: All physios wear white tunics

Conclusion: Lucy wears a white tunic

Get it? Of course you do.

So the two examples above are cases of a good, robust deductive argument – the conclusion is deduced from the premises. We’ll come onto how this looks in an essay in a moment.

Now, here are four types of poor arguments:

Type 1: false premises

This is a simple mistake. Consider the above ‘physio’ example. You would have most likely noticed that the two premises are full of assumptions: 1) that Lucy is in fact a Physio, and 2) that all physios do in fact wear white tunics. The actual truth of the conclusion not only relies on the logical flow, but the accuracy of the detail within that flow. So, an argument can be logically correct – i.e. its logical form is robust, but the factual accuracy of the premises may render it poor.

This is very important in essay writing, and will be address again below.

Type 2: The inductive fallacy (over-generalising)

P1: I have seen 1 white swan

P2: I have seen 2 white swans

P3: I have seen 3 white swans, and so on….

Conclusion: all swans are white

This is a poor argument because it could always be the case that there is a black swan which you haven’t seen. Therefore the generalisation that “all swans are white” is false. So a Physio example:

P1: I have seen ultrasound work on ankle pain once

P2: I have seen ultrasound work on ankle pain twice

P3 ….n: etc etc

Conclusion: Ultrasound works for ankle pain

Type 3: another type of over-generalising – ideas and data

P1: There has been a lot of music in Nottingham lately

P2: Lots of people think that Nottingham is the music capital of Europe

Conclusion: Nottingham is the music capital of Europe

So the conclusion is not necessarily true, even though the premises might be true. Why?  Well, there are two issues:

i) Although the premises might be true, their relationship with each other, and the conclusion, is tenuous. Compare the robustness of the relationship between components in the first Socrates example, with those here.   See how the concepts of ‘mortality’ and ‘Socrates’ are distributed between the premises, linked by the idea of ‘man’.  Notice that ‘man’ does not appear in the conclusion – that idea has already done its job. ‘Socrates’ and ‘mortality’ are the only ideas that re-appear in the conclusion.

In the music example, there is no such pattern. Both ideas of ‘music’ and ‘Nottingham’ appear in both P1 and P2. They are not linked by a central, meaningful idea. P1 and P2 are simply independent commentaries on a similar theme.

Also note that in the Socrates example, both P1 and P2 are necessary conditions for the conclusions, as well as being independently insufficient for it, i.e. they are needed by each other, and by the conclusion. These relationships do not exist in the music example, e.g. that a lot of people thinking that Nottingham is the music capital of Europe is not a necessary condition for Nottingham being the music capital of Europe.

ii) There is missing data! To claim that “Nottingham is the music capital of Europe” relies on something other than what has happened in Nottingham and what people think. It relies on the music rate in other European cities.

MUSIC BREAK: Da da da da da da da da daaaa

As it happens, Nottingham most likely is the music capital of Europe! For example, here’s a great band which comes from Nottingham:

https://skiffleshow.bandcamp.com/album/escape-this-wicked-life

and you can “like” their Facebook page here:

https://www.facebook.com/dhlawrenceandthevaudevilleskiffleshow

MUSIC BREAK OVER.

Type 4: alternative explanations

Premise 1: Contraceptive pills prevent unwanted pregnancy.

Premise 2: John takes the contraceptive pill and he isn’t pregnant.

Conclusion: The contraceptive pill prevented John’s unwanted pregnancy.

Here, again, both P1 and P2 may well be true, but the conclusion isn’t true because there is an obvious alternative explanation for why John does not get pregnant – he is a man.

Constructing arguments in essay form

Now, how does all this relate to your academic writing? Simple. This basic line of reasoning is what we look for in your overall writing piece.

Here’s an over-simplified example: Let’s say you set out to write an essay on the effectiveness manual therapy on neck pain. You might structure your argument something like this:

P1:  Manual therapy for neck pain has some RCT-level evidence

P2: RCTs give good evidence of effectiveness

C: Manual therapy is effective for neck pain.

This seems fairly simple right? But let’s break it down:

The conclusion is wholly reliant on the truthfulness of the premises. In other words if P1 or P2 were false, so would be the conclusion. Further, P1 and P2 are both necessary yet individually insufficient conditions for C.  Notice that the ideas of ‘manual therapy’ and ‘effectiveness’ are linked by the idea of ‘RCTs’ in the premises, and the ‘RCT’ does not appear again in the conclusion.

The argument has avoided the induction fallacy of over-generalisation. There is no obvious over-generalisation of the conclusion. So, you could have said:

P1: 10 case studies show that manual therapy is good for neck pain

Conclusion: manual therapy is good for neck pain

This would have fallen into the induction fallacy

The premises and the conclusion are satisfactorily related (unlike the music example), and have this avoided the ‘lack of robustness / missing data’ issues. So, you could have said:

P1: 10 case studies show that manual therapy is good for neck pain

P2: a number of authors state that manual therapy is good for neck pain

Conclusion: manual therapy is good for neck pain

This would have been a mistake, as per the music example. There is missing data, e.g. no consideration of tests of effectiveness.

So we can see how easy it is to develop a valid and robust argument to build your essay around. If you have avoided the common errors in logical form, all you need to do now is to test the truthfulness of the individual premises. This means, in the case given here, you would be discussing the relative quality of different types of manual therapy studies, and trying to show that manual therapy has some RCT-level studies, before drawing your logical conclusion. Once you have those conclusions, you can then go on to discuss the consequences / implications / context etc of them.

Remember two main things:

1)      Make sure you have a VALID LOGICAL STRUCTURE

2)      When you have that, the aim of your essay is to DEMONSTRATE THE TRUTH OF THE PREMISES.

If you show these two simple things, you are half-way there. The other half is how clearly and concisely you can write!

And finally, I recommend to buy “Rulebook for Arguments” by Anthony Weston. You can get it for about £4 of Amazon.

Happy arguing 🙂

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Should cervical manipulations be abandoned?

TRANSFER FROM POSTEROUS: ORIGINALLY POSTED ON POSTEROUS JUNE 8, 2012

This is really for physiotherapists, but please feel free to read whoever you are.

The Chartered Society of Physiotherapy (CSP) today reported on a British Medical Journal (BMJ) article by Wand et al about the practice of cervical manipulations.

The news report can be found here, and the original article can be found here.

There is a formal rapid response to the paper found here, which is from a group of physiotherapists.
This brief blog represents my opinions and not necessarily those of the co-authors of the response.

Wand et al conclude with a proposition that “manipulation of the cervical spine should be abandoned”, and call on professional bodies to adopt this stance as a formal policy. This is a strong conclusion which you would hope would be based on firm and conclusive data.  However, this is not the case. The data on risk, by self-admission of the BMJ paper authors, is inconsistent and provides nothing but uncertainty. The best of the data would suggest that adverse events to manipulation is extraordinarily low. The benefits of the intervention are, at worst, comparable with alternatives. The maths is simple at this level. Extremely low risk versus likely benefit. If the logic used to argue for the abandonment of manipulation in the BMJ paper was taken seriously (which is very unlikely), then most interventions in medicine and allied therapies would be scrapped. Take, for example oral contraceptives: risk of thrombosis (much higher than manipulation risks) versus comparable benefit.  Let alone non-medical interventions, like hotel hair-dryers, coffee, pencils, and tampons.

Anyway, these are old and tired arguments and not really central to the issues of the current paper and news story. This isn’t about manipulation. Personally, I have no interested in manipulations per se other than wondering, like anything health professionals do, whether it is of likely benefit for patients.  The concept of manipulations is, however, for some bizarre reason, the source of disproportionate concern and emotion.  And it seems it is this that continues to drive the ‘manipulations’ debate. The evidence is merely (mis)used as a tool to support some fixed, pre-established view-point. The ‘Head to Head’ stand-off in today’s BMJ was contrived and non-informative to all involved.  In some ways, the authors were victims of some mis-guided editorial whim.

The real issues at hand though are deeper. This is about the fervent, over-enthusiasm to drag something meaningful out of meaningless data in attempts to appear scientific and contribute to evidence-based practice, whilst paradoxically being pseudo-scientific and missing the point of evidence-based practice.  The potential harmful effects on associated professions and their patients are irreparable.  Physiotherapy is slowly but surely becoming stripped of all its worth.  A hundred-plus years of development and progress based on logic, intellect and science is undergoing painful erosion.  Interventions once the realm of the profession are being thrown out and taken up by others; exercise prescription, manual therapy, electro-therapy. We are becoming experts in handing out advice pamphlets. This is NOT because the interventions are ineffective. It is because they are deemed to have questionable efficacy based on sorry scraps of ‘evidence’ salvaged to adhere to the rhetoric of evidence-based practice.  Remember, most research findings are false (J.P.A. Ioannidid PLoSMed. 2, el124;2005), and this is more-so the case in physiotherapy (R. Kerry et al J Eval Clin Prac).

Very rarely is data considered in a scientific manner: in context of a priori beliefs; in context of the professional background for which it is intended; in the context of the dynamism of scientific discovery; in context of what we understand by cause and effect; in context of individual patients. Today’s claim of “abandoning manipulations” is simply another ludicrous reminder of the state we are in.  The CSP’s reporting is another example of a body blind to the deterioration of its very own profession.

POSTEROUS VIEWS: 670

POSTEROUS COMMENTS

Kevin Kelly responded:
I am in total agreement. It is unfortunate that the drugs industry is a multi-billion pound industry with tremendous lobbying power….any treatment that reduces the amount of drugs prescribed and helps patients should be used not criticised.The cherry-picking of poor quality research needlessly raises alarm in patients and does little to help the people suffering from neck pain and headaches to choose the most appropriate treatment.Neck manipulation has been shown to be safe and effective and benefits thousands of people suffering from neck pain and headaches. In fact, the risk of a stroke after treatment is the same whether you see a GP and get a prescription or see a chiropractor and get your neck adjusted.http://www.ncbi.nlm.nih.gov/pubmed/18204390

Manipulation of the neck is at least as effective as other medical treatments and is safer than many of the drugs used to treat similar conditions.http://www.ncbi.nlm.nih.gov/pubmed/17258728

11 months agoreid_heather (Twitter) responded:
Here hereAs a lecturer and teacher of spinal manipulation for 20years one can only assume that such articles are fuelled by ignorance.manipulation is a highly effective method of alleviating pain whose cause or source lies within the cervical spine. It is a skill we as physiotherapists should embrace rather than through fear discard. Whilst it has been shown that manipulation of the thoracic spine for some patients with cervical symptoms can be effective one must note the SOME. If we don’t continue to use these skills we will lose them. I certainly have not been a member of this profession for over 30 years to become reduced to leaflet giving.

I don’t usually have a rant about such matters but having just revised the history of medicine with my 16 year old daughter it seems that myths about health can be so powerful and disabling that it can prevent further progress. Whilst I do not suggest we reconsider Hippocrates take on the four humours and the balance of opposites he did give us a philosophical base to progress,whilst others thought illness was due to the anger of the Gods or evil spirits.

Benefits can be risky, however physiotherapists are also highly qualified in assessing the risk, and would only act when the risk is absolutely minimal.

11 months agoTaylorAlanJ (Twitter) responded:
So it all becomes clear! The BMJ have just made the web pages ‘pay per view’ . . . So it truly was a cynical marketing ploy that some folks fell for . . . Hook line and sinker!But where were the CSP when we needed them? . . . Sucking it all in and regurgitating it for good measure. None of this is helpful to a dying profession!It is ALL cumulative . . . In the last 2 months G.P’s have been given the impression that Whiplash injury doesn’t exist and now manipulation is harmful . . .

Who is standing up??

I have published my views in more detail onhttp://alteredhaemodynamics.blogspot.co.uk/

AJT

11 months agoHoward Turner responded:
Roger: beautifully put and a grave concern; there is no way to reverse this agenda if it goes too far. Has it gone too far already?My jubilee was a very wet tent in Wales – excellent thank you!
11 months agoRoger Kerry responded:
Hi Howard
Thanks for your supportive comments. Has it gone too far already? I think we are starting to see a generation of ‘de-skilled’ practioners coming through. If there was overwhelmeing evidence to confidently refute skill-based interventions, this would be fine, but there’s not.Hope your tent has dried out – Stick to leafy Cheshire!
10 months agoSteve Robson responded:
Roger makes many good points here about the erosion of skills within physiotherapy. This discourse regarding the safety of manipulation has come and gone many times over the years without resolution. But are we overlooking some fundamental issues here? Before those interested parties within physiotherapy once again ‘lock horns’ in an intra and inter professional struggle to retain their status as manipulators, what is it we as a profession feel is so valuable about manipulation?In circumstances of patient centred treatment and evidence based medicine, any treatment or mode of clininical management logically has to engage with the biopsychosocial status of each patient.
In terms of clinical reasoning, isn’t it essential that we attempt to answer some fundamental questions central to the use of manipulation? After all, decisions based on the use of manipulation as a technique come before an estimation of its safety is even necessary. From this perspective;(1) Essentially what is manipulation? (a definition if you like).
(2) Why are we using it, in other words, what do we hope to achieve by using manipulation?
(3) What are the mechanisms of manipulation, or quite simply, how does it work?

The answers to the above should drive the clinical reasoning process, and as such, what is best for the patient. Without this information evdence based clinical reasoning is not possible.
I would be genuinely interested to hear answers to the three questions above from those of us in physiotherapy who use manipulation.

Essentially, without this information the whole discussion regarding the use of manipulation at all is null and void.

10 months agoRoger Kerry responded:
Thanks for these comments Steve.
I agree that there are fundamental questions to be asked about all aspects of practice. Perhaps reducing the discussion to this level will help in understanding precisely what we are aiming for in clinical practice and research. Did you used to do a MT course exploring these issues?
10 months agoAlan responded:
I am a physiotherapist myself and it seems more and more that in order to continue with manual therapy in Britain I should have qualified in osteopathy or other related profession.It is no wonder that most of the private practice jobs in this country are being filled with our colleagues from the southern hemisphere, renowned for their manual therapy skills.I worry that the UK trained physiotherapist will be having more of an identity crisis in the years ahead!

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