Author's response

AUTHOR’S RESPONSE Editor, I appreciate Ms Hough’s interest in the clinical problem-solving article To tip or not to tip? In support of ‘clinical experience’ and the conclusion ‘considering all the evidence’, the justification not to advise modified positioning for all infants with CF refers not solely to this one case study, but is acknowledgement of evidence-based practice. Evidence based medicine involves integrating individual clinical expertise and the best external evidence available from systematic research (Sackett et al., 1996). I am neither aware of any published detailed scientific research, nor do I have clinical experience, which implicates the head downwards position as adversely affecting GOR in infants. In order to instigate optimim physiotherapy management for this child, as we do for every child under our care, we considered the external scientific evidence that was available combined with experience from clinical practice. As far as gravity is concerned, there is stronger scientific evidence to support the hypothesis that the head downwards position may discourage GOR rather than exacerbate it (Sindel et al., 1989). For the term ‘sound scientific backing’ I am grateful for the opportunity to refer the reader to Nelson (1934). Gillian Phillips Royal Brompton Hospital London REFERENCES Nelson HP. Postural drainage of the lungs. British Medical Journal 1934; 2: 251–255. Sackett DL, Rosenberg WM, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. British Medical Journal 1996; 312: 71–72. Sindel BD, Maisels MJ, Ballantine TVN. Gastro-esophageal reflux to the proximal esophagus in infants with bronchopulmonary dysplasia. American Journal of Diseases in Childhood 1989; 143: 1103–1106. Letters 210

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AUTHOR’S RESPONSE

Editor,I appreciate Ms Hough’s interest in the clinical problem-solving article To tip or notto tip? In support of ‘clinical experience’ and the conclusion ‘considering all the evi-dence’, the justification not to advise modified positioning for all infants with CFrefers not solely to this one case study, but is acknowledgement of evidence-basedpractice. Evidence based medicine involves integrating individual clinical expertiseand the best external evidence available from systematic research (Sackett et al.,1996). I am neither aware of any published detailed scientific research, nor do I haveclinical experience, which implicates the head downwards position as adverselyaffecting GOR in infants. In order to instigate optimim physiotherapy managementfor this child, as we do for every child under our care, we considered the external sci-entific evidence that was available combined with experience from clinical practice.

As far as gravity is concerned, there is stronger scientific evidence to support thehypothesis that the head downwards position may discourage GOR rather thanexacerbate it (Sindel et al., 1989).

For the term ‘sound scientific backing’ I am grateful for the opportunity to referthe reader to Nelson (1934).

Gillian PhillipsRoyal Brompton Hospital

London

REFERENCES

Nelson HP. Postural drainage of the lungs. British Medical Journal 1934; 2: 251–255.Sackett DL, Rosenberg WM, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what

it is and what it isn’t. British Medical Journal 1996; 312: 71–72.Sindel BD, Maisels MJ, Ballantine TVN. Gastro-esophageal reflux to the proximal esophagus in infants

with bronchopulmonary dysplasia. American Journal of Diseases in Childhood 1989; 143:1103–1106.

Letters210

PRI 1(3) 15/12/05 4:44 pm Page 210