ArticlePDF AvailableLiterature Review

Abstract and Figures

This article presents an overview of the philosophy of science and applies such philosophical theory to clinical practice within physiotherapy. A brief history of science is followed by the theories of the four most commonly acknowledged philosophers, introduced in the context of examples from clinical practice. By providing direct links to practical examples, it demonstrates the possibilities of relating the logical basis of this field of study to the clinical setting. The relevance to physiotherapy is that, by relating this theory, clinicians can better understand and analyse the fundamental logic behind their practice. The insight this provides can benefit professional development in several ways. For the clinician, it permits more comprehensive and coherent reasoning and helps to relate evidence with respect to individual patients. On a larger scale, it encourages reflective discussion between peers around the virtues of alternative treatment approaches. Thus, this topic has the potential to guide clinical practice toward being more scientific and may help raise the credibility of the profession as a whole.
Content may be subject to copyright.
This article was downloaded by:
[University of Nottingham]
5 January 2009
Access details:
Access Details: [subscription number 788772475]
Informa Healthcare
Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House,
37-41 Mortimer Street, London W1T 3JH, UK
Physiotherapy Theory and Practice
Publication details, including instructions for authors and subscription information:
Philosophy of science and physiotherapy: An insight into practice
Roger Kerry a; Matthew Maddocks b; Stephen Mumford c
a Associate Professor, Division of Physiotherapy Education, University of Nottingham, Nottinghamshire, UK b
Division of Physiotherapy Education, University of Nottingham, Nottinghamshire, UK c Department of
Philosophy, University of Nottingham, Nottinghamshire, UK
Online Publication Date: 01 November 2008
To cite this Article Kerry, Roger, Maddocks, Matthew and Mumford, Stephen(2008)'Philosophy of science and physiotherapy: An
insight into practice',Physiotherapy Theory and Practice,24:6,397 — 407
To link to this Article: DOI: 10.1080/09593980802511797
Full terms and conditions of use:
This article may be used for research, teaching and private study purposes. Any substantial or
systematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply or
distribution in any form to anyone is expressly forbidden.
The publisher does not give any warranty express or implied or make any representation that the contents
will be complete or accurate or up to date. The accuracy of any instructions, formulae and drug doses
should be independently verified with primary sources. The publisher shall not be liable for any loss,
actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directly
or indirectly in connection with or arising out of the use of this material.
Physiotherapy Theory and Practice, 24(6):397–407, 2008
Copyright rInforma Healthcare
ISSN: 0959-3985 print/1532-5040 online
DOI: 10.1080/09593980802511797
Philosophy of science and physiotherapy: An insight
into practice
Roger Kerry,
Matthew Maddocks,
and Stephen Mumford
Associate Professor, Division of Physiotherapy Education, University of Nottingham, Nottinghamshire, UK
Division of Physiotherapy Education, University of Nottingham, Nottinghamshire, UK
Department of Philosophy, University of Nottingham, Nottinghamshire, UK
This article presents an overview of the philosophy of science and applies such philosophical theory to
clinical practice within physiotherapy. A brief history of science is followed by the theories of the four
most commonly acknowledged philosophers, introduced in the context of examples from clinical
practice. By providing direct links to practical examples, it demonstrates the possibilities of relating the
logical basis of this field of study to the clinical setting. The relevance to physiotherapy is that, by
relating this theory, clinicians can better understand and analyse the fundamental logic behind their
practice. The insight this provides can benefit professional development in several ways. For the clin-
ician, it permits more comprehensive and coherent reasoning and helps to relate evidence with respect to
individual patients. On a larger scale, it encourages reflective discussion between peers around the
virtues of alternative treatment approaches. Thus, this topic has the potential to guide clinical practice
toward being more scientific and may help raise the credibility of the profession as a whole.
Increasingly, physiotherapy clinicians are
required to practice as scientists. They must reason
their clinical decision making, deliver practice
in light of best available evidence, and build upon
their knowledge and expertise to fulfil the pro-
fessional responsibilities set out by governing
bodies (CSP, 2007a,b; Higgs and Titchen, 1998).
Amongst peers, clinicians also have to justify why
they follow a particular treatment approach or
favour one therapeutic modality over another.
There is a constant demand to communicate jud-
gements in a logical, coherent manner.
An appreciation of the philosophy of science
may help clinicians explore the logic underlying
their clinical practice. This field of philosophy
examines the assumptions, foundations, and impli-
cations of science (Klee, 1997), as well as the
manner in which it progressively explains pheno-
mena and predicts occurrences with more accuracy
(Chalmers, 1999; Ladyman, 2002). Understanding
philosophers’ theories can help clinicians gain
insight into their reasoning; formulate logical,
coherent arguments to justify their practice; and
relate evidence with regard to individual patients.
As a result, they should be better equipped to
engage in challenging discussions with peers to
debate various treatment choices and contest their
own and each other’s practice. Thus, the application
of philosophical theory can not only help indivi-
duals develop their practice but may guide overall
clinical practice and raise the credibility of the
profession as a whole.
Previous health science authors have discussed
aspects of philosophies of science in the context
Accepted for publication 19 December 2007.
Address correspondence to Roger Kerry, Division of Physiotherapy Education, University of Nottingham, Hucknall
Road, Nottingham NG5 1PB, UK. E-mail:
Downloaded By: [University of Nottingham] At: 12:38 5 January 2009
of their discipline: physiotherapy (Noronen and
¨m-Grotell, 1999; Parry, 1997; Robertson,
1995; Robertson, 1996), chiropractic (Coulter,
1991), and nursing (Nyatanga, 2005). However,
these are generally targeted toward researchers and
seldom attempt to relate philosophical theory to
clinical practice. Therefore, the utility of this topic
to clinicians may seem unclear.
This article provides a brief overview of classic
and contemporary philosophies of science and
relates them directly to examples of physiother-
apy practice. The main text begins with a brief
historical background to science. Thereafter, the
four most commonly acknowledged philosophies
are covered under subheadings that refer to the
main premise of each. Subsections begin with
boxed text in which an example from clinical
practice and the clinician’s thoughts are pro-
vided. The practice is then examined in light of
the philosophical theory. We demonstrate this as
a mechanism for clinicians to gain more under-
standing of the science underpinning their prac-
tice, which can benefit professional development.
Philosophies of science
Historical background to scientific
Throughout history humans have been fasci-
nated with understanding how things work and
the pursuit of truth. Truth has been sought
through many methods of enquiry. These have
ranged from faith in the mystical to structured,
systematic approaches. The latter methods can
be considered as scientifically superior, and the
validity of these methods lies in the strength of
the logical basis in which they are embedded
(Fisher, 2008). The concept of logic was deve-
loped by Aristotle (384–322 B.C.) and was
arguably the most important development in
mechanisms of inquiry and decision making
(Tarnas, 1996). Aristotelian logic is referred to
as naive deduction. This means that from the
premises of A and B, someone can deduce C
(logical conclusion). For example:
Premise A: All back pain is related to a disc
Premise B: Mr X has back pain.
Conclusion C: Mr X’s back pain is related to
a disc dysfunction.
Thus, if premises A and B are true, then it is a
logical necessity that C is also true (discussing the
truth of premises A and B is beyond the scope
of this article). According to this Aristotelian
thought, it would be illogical, and therefore less
valid, to simply state ‘‘Mr X has intervertebral
disc dysfunction,’’ without the support of the
preceding premises.
Later on, during the scientific revolution,
Francis Bacon (1561–1626) proposed a new tool
novum organtum—as the basis for scientific
method (Jardine and Silverthorne, 2000). In con-
trast to Aristotelian naı
¨ve deduction, Bacon’s
method of induction relies on observation, rather
than logical inference, as the basis for proposing
truthful statements. According to Bacon, obser-
vational experiments are relied upon to establish
laws. The observer begins with absolutely no prior
facts or biases regarding the subject of observa-
tion (presuppositionless observation) and simply
accumulates data from which a law or statement
can be induced. The following is an example of
inductive logic:
‘‘If all observed back pain patients have poor
local muscle control then all back pain patients
have poor muscle control.
Before becoming aware of these observation
results, I had no opinion on what the causes of
low back pain would be.
I now have 20 years experience and have seen
over 1000 patients with low back pain. I recog-
nise a pattern, based on my experience, of back
pain being related to poor muscle control.
Therefore my next patient with low back will
also have poor local muscle control.’’
Induction remained the epistemological basis of
scientific discovery until the early 20th century
when the method of scientific enquiry was sig-
nificantly challenged (Chalmers, 1999). The fol-
lowing sections present four simple clinical
reasoning scenarios, which are examined in line
with the four most reported 20th-century philoso-
phies of science. It is anticipated that these will pro-
vide the reader with an insight into how the logical
basis of clinical practice can be philosophically
398 Kerry et al. /Physiotherapy Theory and Practice 24 (2008) 397–407
Downloaded By: [University of Nottingham] At: 12:38 5 January 2009
Philosophy in clinical practice 1:
Falsification and the demarcation of
Clinician’s thoughts:
The clinical thought process depicted above is
referred to as hypothetico-deductive reasoning. It
is a common reasoning strategy among experi-
enced clinicians and is considered as a robust and
effective mechanism of enquiry (Higgs and Jones,
2000). The philosophical basis of this process
differs from both naı¨ve deduction and inductive
logic and is representative of falsification theory
developed by Karl Popper (1902–1994). Popper
was a proponent of the experimental model and
developed arguments against the inductive method
highlighting its many logical flaws (Popper, 1980;
Salmon, 1988).
Primarily, Popper argued that presupposition-
less observation (the inductive prerequisite of
observations having no bias) is not possible, given
the rich and complex nature of human perception
(Popper, 1963). His concern was that if induc-
tion is used to define or demarcate a discipline as
scientific, and inductive logic is flawed, all those
disciplines that claim to be scientific (and thus
virtuous) on this basis might not actually be so.
A revised criterion of falsification was put
forward for the demarcation of scientific activity
(Popper, 1980, pp 34–42). This entailed that to be
scientific, a discipline must hold theories from
which derivative predictions (hypotheses) can be
deduced that are testable and capable of being
falsified (Figure 1). Popper used the early 20th-
century practice of psychoanalysis to highlight
the demarcation between science and what he
termed pseudo-science (Popper, 1963). He was
disturbed that the psychoanalysts were making
strong proclamations that their discipline was
scientific. Freud and Adler theories could be used
to explain any conceivable event. In this case, the
inherent vagueness of the theories renders them
unfalsifiable and therefore not scientific.
Many other disciplines (e.g., political move-
ments, astrology, and homeopathy) attempt to pro-
claim scientific status, but in Popperian terms are
actually nothing more than science-masqueraders.
This phenomenon has been referred to as the
‘‘pseudo-scientific hijacking’’ of science (Dawkins,
1998). On a social level this is much more than
academic semantics and has extreme detrimental
Predictions Tested
(Hypotheses) (Deductive)
(Derived) - Logical deduction
Temporarily “Verified”
Permanently “Falsified”
Corroborated Falsified
Figure 1. Scientific structure according to Popper describing the process of falsification (authors’ own).
‘‘I hypothesise that this patient’s back pain
is most likely due to 4 possible factors:
1) facet joint dysfunction;
2) poor local muscular control;
3) disc dysfunction; or
4) a combination of these.
I will now systematically attempt to falsify
each hypothesis through questioning and
physical examination. The hypothesis which
survives these tests to the greatest extent is the
most likely factor influencing this back pain.’’
Kerry et al. /Physiotherapy Theory and Practice 24 (2008) 397–407 399
Downloaded By: [University of Nottingham] At: 12:38 5 January 2009
effects on the public understanding of science.
Popper logically challenged the proposition that
inductive method was the criterion of demarca-
tion. He dismissed how induction used tautology
and language philosophy to ‘‘prove’’ the meta-
physical ‘‘nonsensical twaddle’’ of pseudo-
scientific disciplines (Popper, 1980, p 35). The
dogmatic and institutionalised teaching and
training of physiotherapy cults, together with the
unfalsifiable and panacean proclamations of the
physiotherapy ‘‘theorists,’’ are perhaps examples
of physiotherapy entering the domain of pseudo-
science (Rivett, 1999). Examples of practices
involving unfalsified and unfalsifiable theories are
shown below. According to Popper’s way of
thinking, these practices demarcate a disciple as
being pseudo-scientific.
a) Unfalsified theory: I have a theory of
‘movement impairment’ which explains
this back pain. I am so convinced by
this explanation that I do not need to
consider other explanations nor test
my theory. I will begin treating right
away in accordance with this theory.
b) Unfalsifiable theory: My theory of
movement impairment cannot be
argued against as I can always find
some sort of movement dysfunction
in anyone. If someone else does find
out that a movement impairment does
not relate to the pain, I can find
another movement impairment which
will explain the pain. I can continually
remodel my theory so it can never fail.
A second Popperian principle regards the nat-
ure of a hypothesis (Popper, 1980, pp 252–281).
To improve its scientific value, a hypothesis
should have as high an informative and non-
tautological content as possible, whilst still being
probable (Popper, 1980, pp 146–215). In contrast,
induction dictates that we should aim to develop
statements (general laws) with maximal prob-
ability. For example, stating: ‘‘either this back
pain is related to movement dysfunction or it is
not’’ fulfills the inductionist criterion. It may have
maximized probability to 100% truth, but it does
not help decide a meaningful diagnosis or man-
agement strategy.
Philosophy in clinical practice 2:
Scientific revolution and paradigms
Clinician’s thoughts:
The clinician’s thought process above repre-
sents a reflective and adaptive practitioner. In an
age of evidence-based practice, self-reflection,
and continual professional development, the
insight offered in this thought process makes it a
I have been managing back pain patients for
a number of years using muscular-fascial
theory (i.e., pain is related to restrictions in
movement caused by the myofascial system).
Treatment of this system seemed to produce
great results in my patients. The odd patient
would sometimes not respond well, but
overall it was a great theory.
However, recently I have been working in an
environment where I see more patients for
longer term follow-up, my questioning and
communication have improved, and it
appears that there are many patients who
are not responding to this approach.
I can no longer use my theory to explain what
is happening and I now have to question its
value in the presence of so many unsuccessful
clinical outcomes.
Upon further education and reflective prac-
tice I am learning that non-biological factors
affect the prognosis of someone’s back pain
I am continuing to develop ways of assessing
and managing treatment within my new
paradigm and will eventually be comfortable
practicing within this new framework.
When I think back to the old theory, or talk
to colleagues who continue to use a purely
structural approach, there is difficulty coming
to agreement about the nature of back pain
Of course, my patients still have specific
myofascial or movement dysfunctions which
I do address, but within the context of the
non-biological factors which can influence
their pain experience.
400 Kerry et al. /Physiotherapy Theory and Practice 24 (2008) 397–407
Downloaded By: [University of Nottingham] At: 12:38 5 January 2009
professionally responsible and virtuous one. In
essence, this thought process represents a chang-
ing paradigm within the clinician’s practice. This
concept is attributed to a philosopher of science
called Thomas Kuhn (1922–1996).
In contrast to Popper’s view that a theory can
be broken down into small falsifiable pieces, which
in turn can be disregarded or put back into the
theory, Kuhn suggests that a theory is a whole,
irreducible package. He called these packages
paradigms (Kuhn, 1972). In Kuhn’s view it is the
acceptance of a single paradigm in a discipline that
will demarcate a science from a non-science, not
whether hypotheses within that paradigm are
falsifiable. This view does not see science as a
steady progression influenced by the accumulation
of knowledge. Rather, it proposes that science
involves the wholesale acceptance and subsequent
abandonment of paradigms. This process is coined
ascientific revolution (Kuhn, 1972). Examples of
such revolution include the shift from thinking that
planets and stars move around the Earth (geo-
centrism) to the Copernican theory that planets
move around the Sun (heliocentrism), or the move
from Newtonian physics to Einsteinian theory
(Ladyman, 2002). In physiotherapy, the shift from
a tissue-based model for low back pain toward a
theory led by the increasing importance of psycho-
social components of pain represents such a revo-
lution. These examples demonstrate a wholesale
abandonment of one theory—or paradigm—in
favour of another. Thus, Kuhn (1972) refers to this
activity as a paradigm shift.
So what is it that makes a science shift its under-
pinning paradigm? Kuhn describes a number of
stages leading up to the point in time when the
scientific discipline totally revolutionises its activity
(Figure 2).
In a state of normal science, the scientist works
uncritically of the underpinning theory. The scien-
tist’s job is to collect data that fit in with the
assumptions of that paradigm. Data that do not
fit the paradigm is dismissed as being erroneous
(as a result of the scientist’s poor work). However,
there may come a point when these misfitting
data become overwhelming and start to threaten
the basic assumptions of the paradigm. Thus, the
discipline reaches a state of anomaly. If these data
continue and evade or resist explanation, the
discipline moves into a state of crisis. During this
state, an alternative framework of thought will
develop and eventually revolutionise the scientific
discipline. A period of new immature research
activity begins whilst the new paradigm is being
accepted before once again normal, uncritical
scientific activity resumes within that paradigm.
The nature of a paradigm and the inter-
pretation of results emerging from within that
paradigm are two additional concepts to which
Kuhn pays particular attention (Kitcher, 2002;
Lewens, 2005). Respectively, these are known as
the ‘‘incommensurability’’ of paradigms and the
‘‘theory-ladenness’’ of data. An essential charac-
teristic of a new paradigm is that it is incom-
mensurable with the competing paradigm (i.e.,
there is no straightforward way of comparing the
two). This means that the detail, the language,
and the whole underpinning framework is so
different between paradigms that the scientist
must learn to operate in a completely new way.
Figure 2. Kuhnian Scientific Revolution (authors’ own interpretation from Kuhn, 1972).
Kerry et al. /Physiotherapy Theory and Practice 24 (2008) 397–407 401
Downloaded By: [University of Nottingham] At: 12:38 5 January 2009
It also means that scientists from each paradigm
have no common language with which to com-
municate. For example, it would be impossible
for a Newtonian physicist to resolve a problem
associated with mass in collaboration with
an Einsteinian physicist, because the Newtonian
concept of mass is different from the Einsteinian
concept (Okasha, 2002). The detail is so embed-
ded in the competing underpinning theories that
singular comparison of detail cannot be made.
This theory-relative view of detail is also the
premise of Kuhn’s thoughts regarding the theory-
ladenness of data. As above, Kuhn argues that
traditionalist views of science are erroneous in
that they attempt to make science too objective.
Kuhn’s holistic interpretation means that to
attempt to analyse data in isolation from its
underpinning theory is wrong—all data is conta-
minated with theory. This immediately questions
the validity of the concept of objective truth (i.e.,
this theory-ladenness notion implies that truth is
relative to the environment from which it emer-
ges). Indeed, Kuhn’s philosophy is regarded as a
major driving force for sciences, in particular the
social sciences, to embrace the cultural, social, and
environmental relativism of truth (Longino, 1990).
By relating these concepts of Kuhnian philo-
sophy of science to clinical practice, the clini-
cian’s thought process can now be superimposed
onto a framework of scientific activity. This is
demonstrated in Figure 3.
Philosophy in clinical practice 3:
Sophisticated methodological
Clinician’s thoughts:
This thought process represents a develop-
ment from both Popperian and Kuhnian models.
It appears to embrace a core paradigm (movement
theory) whilst at the same time develop specific,
falsifiable ideas (e.g., joint dysfunction and disc
dysfunction) that contribute to the overriding para-
digm. This thought process is aligned to philoso-
phicalconceptofaresearch programme, and more
completely, Sophisticated Methodological Falsifi-
cation. These concepts have been developed by
philosopher Imre Lakatos (1922–1974).
Lakatos worked on his philosophy during the
1960s whilst based in the same department as Karl
Popper, whose theory of knowledge in part ins-
pired his ideas. Lakatos (1999c) did not advocate
for inductivism but favoured deductive explanation
born through trial and error. Lakatos’s first
standpoint is that theories offering explanations to
problems must come in whole packages rather than
by piecing together individual observation state-
ments as Popper allowed. He proposed that theo-
ries originate as a vague set of key ideas and
concepts, which are developed and clarified as the
theory grows (Lakatos, 1970, p 173). The gene-
ration of proof or evidence for or against a com-
plete theory should not serve to close the issue but
to allow the theory to be modified or grow. The
proof procedure, to Lakatos, is essentially a long
process of fumbling and trying again and again.
He presents theories as opportunities for growth
(in knowledge) and coins them ‘‘research pro-
grammes’’ (Lakatos, 1970, p 132; Lakatos, 1999b).
Each research programme contains two coex-
isting heuristics (approaches to discovery or pro-
blem solving) that provide both negative and
positive guidance. The negative heuristic involves
an unchallengeable core of basic assumptions,
ideas, or concepts that are proven and universally
supported. In the boxed example above the core
theory is that low back pain is related to move-
ment dysfunction (pathokinesiology), a notion
I am quite certain that on a basic level, back
pain is related to some form of movement
dysfunction. This assumption of pathokine-
siology is so basic, generic, and supported
within the sphere of manual therapy that it is
essentially unchallengeable.
However, I have other ideas that are more
specific (e.g., joint dysfunction, disc dysfunc-
tion, myofascial dysfunction, local muscle
control, and psycho-social theories). Some of
these ideas may turn out to be invalid. Others
might continue to be successful theories I use
in my practice.
It is, however, unlikely that my core theory
of movement dysfunction is going to be
radically falsified or revolutionised due to its
adaptability and acceptance by practitioners
over many decades.
402 Kerry et al. /Physiotherapy Theory and Practice 24 (2008) 397–407
Downloaded By: [University of Nottingham] At: 12:38 5 January 2009
that most clinicians would support. Any obser-
vations that are contrary to this core do not serve
to refute the theory. Instead, they encourage the
formulation of supplementary hypotheses that
serve to build a ‘‘protective belt’’ around the core
(Lakatos, 1999b). These supplementary hypo-
theses represent the positive heuristic, a list of
anomalies or peripheral assumptions that need to
be worked on. Unlike the core, these are refutable
and should be adjusted accordingly following
Figure 3. Kuhnian philosophy: Analysis of clinician’s thoughts.
Kerry et al. /Physiotherapy Theory and Practice 24 (2008) 397–407 403
Downloaded By: [University of Nottingham] At: 12:38 5 January 2009
observations (Lakatos, 1970). In the example
provided, myofascial theory and local mus-
cle control serve as peripheral assumptions to the
core theory of pathokinesiology. If evidence in
support of either these assumption arises, the
‘‘low back pain is related to movement dysfunc-
tion’’ theory is developed and might incorporate
reference to the particular assumption concerned.
Equally, if observations refuting an assumption
arise, this assumption would no longer supple-
ment the core theory and would be modified or
abandoned (Lakatos, 1970, pp 134–135).
The success of each research programme (or
theory) is dependent on its longevity; the length of
time it withstands tests of refutation. If adjust-
ments to the assumptions in the protective belt
permit new predictions, which are consequentially
corroborated, these add to the cumulative growth
of the theory (Lakatos, 1999a). Conversely, if
observations consistently refute the peripheral
assumptions, these degenerate and no longer serve
to protect the core. If this happens repeatedly to
the majority of the assumptions, the theory is left
unprotected, ceases to grow, and is ultimately
abandoned. This process is termed Sophisticated
Methodological Falsification (SMF) (Lakotos,
1970, p 122) and may be seen as an extension of
the Popperian concept of falsification. SMF may
provide a more realistic and encompassing reflec-
tion of how a clinician might practice. Reasoning
is usually based on several components or aspects
of an underlying theory. Therefore, falsification
of a single component does not mean the entire
theory is abandoned; rather, parts of it are deve-
loped and the practice of that theory is modified.
Figure 4 demonstrates SMF as a framework in
which this can take place.
Lakatos also states ‘‘there is no falsification
before the emergence of another theory; theories
are not falsified by data but other theories’’
(Lakatos, 1970, p 119). This conceptual introduc-
tion that theories compete against one another is
important. Thus, the paradigm shifts proposed by
Kuhn may not be radical changes in thought, but
simply the ‘‘overtaking’’ of one scientific theory
by another (Lakatos, 1970, p 173). Lakatos offers
Figure 4. Sophisticated Methodological Falsification. The negative heuristic of pathokinesiolgy is unchallengeable. Peripheral
assumptions related to this core assumption are falsifiable, and their response to testing will sculpt the clinician’s impression of
404 Kerry et al. /Physiotherapy Theory and Practice 24 (2008) 397–407
Downloaded By: [University of Nottingham] At: 12:38 5 January 2009
a potential resolution to the conflict between
Popper’s concept of falsification and Kuhn’s
revolutionary-based take on scientific develop-
ment. Popper argues scientists should replace
refuted theories with new ones, and Kuhn argues
that evidence against a theory should be dis-
counted (i.e., considered incompatible with that
theory or ignored). Lakatos uses SMF to acknow-
ledge the need to modify peripheral assumptions
as a process to dictate the growth or otherwise of a
theory and determine its fate (Lakatos, 1999c).
Philosophy in clinical practice 4:
Science as an ideology
Clinician’s thoughts:
Thus far, the philosophies of science have all
advocated sound reasoning and systematic pro-
gression of thought. The clinician above seems to
have ‘‘given up’’ on the idea that to be correct,
there is a need to be reasonable and logical. But is
this necessarily bad practice? If contemporaneous
professional practice should be embedded in logi-
cal reasoning and the utilisation of sound evi-
dence, then arguably so. This final section offers
an alternative view that science is an unfounded
ideology and a more radical way of thinking is
philosophically justifiable.
Paul Feyerabend (1924–1994) introduced a
view of science that conflicts strongly with pre-
ceding philosophical thoughts (Ladyman, 2002).
Feyerabend (1993) was against all attempts to
rationalise the development of scientific theories
and rebelled against the method in science that
other philosophers promoted. Until this point,
science was built up to be characterised by an
essential scepticism; when observations that refu-
ted a theory came thick and fast, defence of that
theory switched to an attack on it. Feyerabend
(1999) proposed that contrary to carrying this
essential scepticism, most scientists’ beliefs were
protected by a taboo reaction to refutation. He
believed that most scientists showed minimal and
selective scepticism, being sceptic only toward
observations challenging peripheral components of
their own theories (Feyerabend, 1978, pp 88–89).
As ‘‘believers’’ to the core of their theory, scientists
either call for the incompatibility between obser-
vations that challenge it, or simply ignore them. In
this way science has the potential to conceal or
distort the process of gaining new knowledge by
explaining it to fit around itself.
Feyerabend suggests that myth and science are
similar. He did not believe that science deserves
the status it has in society; to him it was just
another ideology (a story we are told is true even
in the absence of justification) amongst many
(Feyerabend, 1993, pp 222–223). Other rival
ideologies, he argued, would work just as well if
you believe them, but because of the dominance
of scientific ideology within the state we are
taught to ignore them (Feyerabend, 1978, p 77).
As a result, the superiority of science cannot be
demonstrated (i.e., science is only ‘‘superior’’
because we judge it to be using the standards
science dictates).
By proposing science as an ideology, rules
become detrimental. They neglect the complexity
of the conditions that influence theory change
and limit the resources available to scientists (now
believers of ideologies) to extend knowledge. The
presence of rules also makes science less adap-
table and more dogmatic; users take for granted
the assumptions that go into their formation
(Feyerabend, 1993, p 231). Feyerabend thought
the idea that science ought to run according to
fixed and universal rules was unrealistic and
I was trained to make assessment and
management decisions for patients based
on reasoned argument, logic, and also to
seek and provide ‘‘evidence’’ whenever pos-
sible. In reward for me demonstrating that
I could do this, I received both a Bachelor
and a Master of SCIENCE degree! How-
ever, I now see that this is possibly just
another way of going about things, and not
necessarily the best way.
At times, I see this method as being restric-
tive to my practice and confining me to
artificial rules made up by those who simply
‘‘believe’’ that this scientific process is some-
how better than other ways. Is Science ignor-
ing the chaotic complexity of human nature
and pain?
Why can I not believe—without question-
ing—in say, the healing powers of magnets,
or faith, or joint mobilisation? Why should
I be forced to believe in the dogmatic,
controlled ideology of science?
Kerry et al. /Physiotherapy Theory and Practice 24 (2008) 397–407 405
Downloaded By: [University of Nottingham] At: 12:38 5 January 2009
pretentious—unrealistic because it offers a very
simplistic view of mans’ talents and pretentious
because it enforces its own rules at the expense
of this humanity.
This philosophy encourages freedom of choice
and ideological neutrality within scientists. Choice
between competing theories should be subjective,
and the only rule should be ‘‘anything goes’’ so
long as it is advanced and developed sensibly
(Feyerabend, 1978, p 39). Feyerabend’s philo-
sophy argues that science as anarchistic enterprise
is more likely to encourage progress than science
operating within rules, orders, and constraints. He
believed that all ideas had the potential to expand
knowledge, even those that do not fit in with
current thought (Feyerabend, 1993, p 62).
This proposal presents a striking antithesis to
the methodology-driven philosophies preceding it.
Superficially, this could be interpreted as a ‘‘green
light’’ to engage in whatever practice the clinicians
likes. This is against the culture of evidence-based
practice and professional accountability that phy-
siotherapy is striving for. However, Feyerabend’s
ideas do not oppose logic as the basis for sensible
development of a theory; they only contend that
methodological constraints may curb creativity. In
practice, this would still necessitate that the clini-
cian uses reasoning and progressive thought in
their decision making. Thus, the reference in the
boxed text above to ‘‘unquestioned’’ practice
would still be considered pseudo-scientific.
The pursuit of truth and knowledge has been
a fascination of mankind throughout history.
Philosophy of science studies and comments on
the methods used by those concerned with this
quest. This area of study makes the assumption
that scientific approaches are virtuous and there-
fore preferable to nonscientific approaches to
problem solving. Thus, the primary concern is
the demarcation of ‘‘true’’ science from pseudo-
science. This article has taken the bold step of
extracting the logic from a number of acknow-
ledged philosophies of science and transferring
it to examples of physiotherapy practice. We
demonstrate this as a mechanism whereby clini-
cians can consider what might philosophically
be seen as good, virtuous practice. By gaining an
insight into the logic underlying their reasoning,
clinician’s can better understand the scientific
rigour of their practice and establish the best
approaches for the future.
Chalmers AF 1999 What is this thing called science? 3rd ed.
Buckingham, Open University Press
Chartered Society of Physiotherapy 2007a Rules of profes-
sional conduct, 2nd edn. London, Chartered Society of
Chartered Society of Physiotherapy 2007b Policy statement
on continuing professional development. London, Char-
tered Society of Physiotherapy
Coulter ID 1991 Philosophy of science and chiropractic
research. Journal of Manipulative and Physiological
Therapeutics 14: 269–272
Dawkins R 1998 Unweaving the rainbow: Science, delusion
and the appetite for wonder, p 18. London, Allen Lane
Feyerabend P 1993 Against method. London, Verso
Feyerabend P 1978 Science in a free society. Norfolk, Lowe
and Brydone Ltd
Feyerabend P 1999 Intellectuals’ betrayal of reason. In:
Motterlini M (ed) For and against method, pp 86–95.
Chicago, University of Chicago Press
Fisher J 2008 Formal logic—an introduction. In: Fisher J
(ed) On philosophy of logic, pp 5–19. Belmont, Thomson
Higgs J, Titchen A 1998 Research and knowledge. Physio-
therapy 84: 72–80
Higgs J, Jones M 2000 Clinical reasoning in the health
professions, 2nd ed. Edinburgh, Butterworth Heinemann
Jardine L, Silverthorne M 2000 The new organon. In: Jardine L,
Silverthorne M (eds) Francis Bacon—The New Organon
Cambridge Texts in the history of philosophy, pp 26–33.
Cambridge, Cambridge University Press
Kitcher P 2002 Theories, theorists and theoretical change. In:
Balashov Y, Rosenberg A (eds) Philosophy of science,
contemporary readings, pp 163–187. London, Routledge
Klee R 1997 Introduction to the philosophy of science—cutting
nature at its seams. New York, Oxford University Press
Kuhn TS 1972 The structure of scientific revolutions, 2nd ed.
Chicago, University of Chicago Press
Ladyman J 2002 Understanding philosophy of science.
London, Routledge
Lakatos I 1970 Falsification and the methodology of scientific
research programmes. In: Lakatos I, Musgrave A (eds)
Criticism and the growth of knowledge. Cambridge,
Cambridge University Press
Lakatos I 1999a Falsification and intellectual honesty. In:
Motterlini M (ed) For and against method, pp 86–95.
Chicago, University of Chicago Press
Lakatos I 1999b The methodology of scientific research
programmes. In: Motterlini M (ed) For and against
method, pp 96–108. Chicago, University of Chicago Press
406 Kerry et al. /Physiotherapy Theory and Practice 24 (2008) 397–407
Downloaded By: [University of Nottingham] At: 12:38 5 January 2009
Lakatos I 1999c The theological nature of scientific
standards. In: Motterlini M (ed) For and against method,
p 63. Chicago, University of Chicago Press
Lewens T 2005 Realism and the strong program. British
Journal for the Philosophy of Science 56: 559–577
Longino HE 1990 Science as social knowledge—values and
objectivity in scientific inquiry, pp 62–187. Princeton, NJ,
Princeton University Press
Norone L, Wiksro
¨m-Grotell 1999 Towards a paradigm-
oriented approach in physiotherapy. Physiotherapy
Theory and Practice 15: 175–184
Nyatanga L 2005 Nursing and the philosophy of science.
Nurse Education Today 25: 670–674
Okasha S 2002 Philosophy of science: A very short
introduction, pp 85–87. Oxford, Oxford University Press
Parry A 1997 New paradigms for old: Musings on the shape
of clouds. Physiotherapy 83: 423–433
Popper KR 1980 The logic of scientific discovery, 4th ed.
London, Routledge
Popper KR 1963 Conjectures and refutations: The growth of
scientific knowledge. London, Routledge
Rivett DA 1999 Editorial—manual therapy cults. Manual
Therapy 4: 125–126
Robertson VJ 1996 Epistemology, private knowledge, and
the real problems in physiotherapy. Physiotherapy 82:
edge in physical therapy. Physical Therapy 75: 223–236
Salmon WC 1988 Rational prediction. In: Gru
¨baum A,
Salmon WC (eds) The limitations of deductivism, pp 47–
60. London, University of California Press
Tarnas R 1996 The passion of the western mind—understanding
the ideas that have shaped our world view, pp 55–68.
London, Pimlico Press
Kerry et al. /Physiotherapy Theory and Practice 24 (2008) 397–407 407
Downloaded By: [University of Nottingham] At: 12:38 5 January 2009
... Presenting insights into the reasoning process enables the formation of clear logical arguments that justify the original research question posed and the research methodology chosen (Kerry et al., 2008). Moreover Collier (1994. ...
... Positivism, the classical view of natural science, introduces the theory of falsification (Kerry et al., 2008) which seeks to disprove hypotheses on the basis that laws or theories are informative only if the observations can be ruled out (Chalmers, 1999, p.63). Inductive logic formed the basis of scientific discovery until challenged by the philosophist Karl Popper (1959) who introduced the falsification theory that enabled the currently fittest theories to survive. ...
The research in this thesis presents insights into elements of healthcare provided in micro-communities that are hidden from public view; prisons in England. Prisons are a key demographic in NHS England’s drive to eliminate hepatitis C virus infection (HCV) as a major public health threat by 2025. A policy to offer blood borne virus testing, with HCV as the priority, to those entering prisons via an opt-out approach was launched in 2014. This policy was implemented in the East Midlands prison estate, comprising 14 establishments, using dried blood spot tests as the default method of obtaining samples for analysis. The research aimed firstly to measure the impact of the opt-out testing policy on HCV test uptake in the East Midlands prisons and secondly to generate explanatory theories, based on the perspectives of men serving prison sentences, which would underpin future interventions to maximise test uptake in prisons. Realistic Evaluation methodology and mixed methods informed the conduct of three study phases: 1. Measurements of HCV test uptake pre-and post-policy introduction and prison operational features; 2. Survey of men in a category C prison to establish sentence duration, HCV test uptake, reasons for refusal and risk factors for HCV infection; 3. Semi-structured interviews with men in prison and nurses to elicit data on their perspectives about testing for HCV infection in prisons. In keeping with the Realistic Evaluation methodology programme theories were constructed to explain the test uptake rates observed in phase 1. These were subsequently refined using the novel data generated in phases 2 and 3. The HCV test uptake fell far short of the targets set by Public Health England and there was evidence of people with risk factors for HCV infection not being tested during their current sentence. The key themes of Fear, Insufficient Knowledge, Stigma, Privacy, Choice and Prison Life emerged as the principal barriers to test uptake. Test Uptake Facilitators were however identified by participants and a positive notion presented of prison healthcare being a Health Farm. In prisons men rarely spoke to each other about HCV and were fearful of catching this infection. Further, if identified as infected social rejection by others in prison was experienced so fears of being found out were high. Moreover, the prison regime which necessarily prioritises security, hampered opportunities for healthcare. Overall most men were accepting of the concept of routine BBV testing on arrival. The dominant qualitative leitmotif and causative mechanism to emerge from the interviews was Fear. This thesis presents a novel model of prison BBV engagement and interventions to increase test uptake, expressed as a Middle Range Theory comprising context-mechanism-outcome configurations embedded within the wider sociological theory about adaptation to prison life; prisonization.
... These can be viewed as representations, or building blocks of existing theory (Rodgers and Knafl, 2000). Theoretical concepts are brought to life through operationalisation as they are reformatted towards the relevant clinical context, a process influenced by sociocultural and professional background (Kerry et al., 2008;Shaw and DeForge, 2012). Although there has been an increase in physiotherapy literature concerning the TA, no agreement exists regarding the TAs conceptual understanding and its subsequent operationalisation or influence on outcomes (Besley et al., 2011;Taccolini Manzoni et al., 2018). ...
... Calls for a more holistic approach in treating people with multifactorial presentations have been made, incorporating more adaptive reasoning, inclusive of the person's social and psychological world (Harman et al., 2014;Lewis and O'Sullivan, 2018;Tasker et al., 2012). Moreover, it was suggested that increased awareness amongst physiotherapists own epistemological stance was necessary to enhance awareness around this paradigm shift and implementation of such change (Bientzle et al., 2014;Kerry et al., 2008). ...
Objective: The Therapeutic Alliance (TA) is an emerging concept within physiotherapy practice, reflecting the ongoing paradigm shift from a biomedical- (BMM) towards a biopsychosocial model (BPSM) of care. Current conceptual understanding of the TA is commonly based on Bordin's (1979) definition, developed within a psychotherapy context. A concept analysis was conducted in order to provide conceptual clarity of the TA within physiotherapy literature. Method: An evolutionary method of concept analysis was followed. An extensive literature search was conducted, and eligible articles were submitted to inductive, semantic thematic analysis. Findings: A total of 14 articles were included within this concept analysis. 5 master attribute themes, and 4 corresponding sub-themes were identified following thematic analysis. The master attribute themes were: 'Seeing the person', 'Sharing the journey', 'Communication', 'Therapeutic space' and 'Fostering autonomy'. The 4 Sub-themes were: 'Giving of self', 'Legitimising the experience', 'Physiotherapist characteristics matter' and 'Interpersonal collaboration'. Conclusion: A heuristic interpretation of the TA within a physiotherapy context is offered. The TA is a dynamic construct within the clinical encounter and is influenced reciprocally between the person seeking care and the physiotherapist by biological, social and psychological contributing factors. 'Communication' may act as a catalyst in operationalising the TA in a physiotherapy context. Continued efforts are needed in physiotherapy education and training in both enhancing theoretical awareness of the role of the TA within physiotherapy practice, as well as guidance on its implementation in clinical practice.
... Kuhn's merit lies in detailing the characteristics and mechanisms of these waves. Figure 1 summarizes the core of the concept of Kuhn's Scientific Revolution Cycle (Kerry et al., 2008). ...
... Responding to calls for a greater theorisation of physiotherapy and the body (e.g. Julius, 1990;Kerry et al., 2008;Nicholls and Gibson, 2012;Setchell et al., 2014;Tyni-Lenne, 1989;Wikström-Grotell and Eriksson, 2012) we 'rifle through' a practice example to highlight that doing physiotherapy enacts multiple bodies -some that are familiar, others that are more unexpected. Using an exemplar scenario of rehabilitation following a hip joint replacement, we investigate the multiple ontologies that are enacted through the use of typical physiotherapy technologies (e.g. ...
Full-text available
Drawing from Annemarie Mol's conceptulisation of multiplicity, we explore how health care practices enact their object(s), using physiotherapy as our example. Our concern is particularly to mobilise ways of practicing or doing physiotherapy that are largely under-theorised, unexamined or marginalised. This approach explores those actions that reside in the interstitial spaces around, beneath and beyond the limits of established practices. Using Mol's understanding of multiplicity as a theoretical and methodological driver, we argue that physiotherapy in practice often subverts the ubiquitous reductive discourses of biomedicine. Physiotherapy thus enacts multiple objects that it then works to suppress. We argue that highlighting multiplicities opens up physiotherapy as a space which can broaden the objects of practice and resist the kinds of closure that have become emblematic of contemporary physiotherapy practice. Using an exemplar from a rehabilitation setting, we explore how physiotherapists construct their object(s) and consider how multiplicity informs an otherwise physiotherapy that has broader implications for health care and rehabilitation.
... Clinical expertise in professional physiotherapy practice requires knowledge of a number of different traditions, not just biomedical knowledge. Kerry, Maddocks and Mumford (2008) argue that assimilating the philosophy of science into clinical practice provides clinicians with greater insight into the logic that underlies decision-making reasoning and facilitates better approaches in practice. Clinical reasoning requires the use of communication skills that are matched to the dialog partner and to the contextual demands. ...
Full-text available
Background: Professional health science education includes a common theoretical basis concerning the theory of science, ethics and communication. Former evaluations by first-year students of the bachelor physiotherapy program at Oslo and Akershus University College of Applied Sciences (HiOA) show that they find it hard to understand the relation between these particular topics and future professional practice. This challenge is the starting point for a pedagogical development project that aims to develop learning contexts that highlight the relevance of these theoretical concepts. Aim: The aim of the study is to explore and present findings on the value of using Sykegrep manual skills classes as an arena in which students can be encouraged to think about, reflect on and appreciate the role and value of the philosophical perspectives that inform their practice and contributes to practise knowledge. Method: A qualitative study with data collection through focus groups was performed and analyzed using thematic content analysis. Eighteen first-year undergraduate students, who had completed the manual skills course, participated in the study. Findings: Analysis of the data yielded three categories of findings that can be associated with aspects of philosophy of science, ethics and communication. These are as follows: 1) preconceived understanding of physiotherapy; 2) body knowledge perspectives; and 3) relational aspects of interactions. Undergraduate students’ understanding and experience of philosophy of science, ethics and communication may be facilitated by peer collaboration, reflection on intimacy and touch and the ethical aspects of interaction during manual skills training. Conclusion: Practical classes in Sykegrep provide a basis for students’ discussions about the body as well as their experiences with the body in the collaborative learning context. The students’ reflections on their expectations of manual skills in physiotherapy and experiences of touch and being touched can facilitate an awareness of philosophy of science, ethics and communication. Implications: Our study will be an incitement to further develop a manual skills teaching program that incorporates philosophy of science, ethics and communication in undergraduate education.
Introduction In mental health physiotherapy, there is a lack of research investigating the assumptions and clinical reasoning strategies of the professionals. A critical view on what is taken for granted within physiotherapy promotes professional development. Purpose The purpose of this study was to explore and describe the essence of clinical reasoning of Austrian mental health physiotherapists, and to illuminate the meaning of their experiences. Method Ten semi-structured individual interviews were conducted with Austrian mental health physiotherapists. The transcripts were analyzed using a phenomenological hermeneutical method. Results The informants’ clinical reasoning emerged as a process of three perspectives: 1) a relational and interactional perspective; 2) a perspective of wholeness; and 3) a perspective of symptoms. The results were then further interpreted using the theories of intercorporeality and bodily resonance. Conclusion To bring the different clinical reasoning perspectives together to one clinical reasoning process, a discourse of reconciliation is suggested as a favorable strategy, which may be useful both in clinical practice and education.
Science changes in waves, the so-called paradigm shifts or scientific revolutions. This concept was prominently elaborated on by Thomas S. Kuhn more than 50 years ago, which remains one of the most cited science philosophy books of all time. Kuhn described how “normal science” experiences anomalies that bring it to crisis and revolution from which a new immature scientific paradigm results, which over time becomes the new normal. Building on an analysis how this applies to toxicology and its change in approach in 2008, we concluded at the time that toxicology has encountered a number of such anomalies and was moving into crisis. In this chapter, the progress along Kuhn’s trajectory over the last 12 years of a scientific revolution is discussed. We conclude that in fact this decade has shown even more anomalies and the perception of crisis has spread and consolidated. Indications of revolutionary paradigm changes are emerging.
Rationale, aims, and objectives Physiotherapists' attitudes toward low back pain (LBP) are linked to patients' attitudes toward pain, chronicity, and disability. Nevertheless, there is a scarcity of studies exploring the variables associated with physiotherapists' attitudes. The present study seeks to explore whether there is an association between the physiotherapists' work setting and their attitudes toward LBP, whether there is an association between the physiotherapists' clinical experience with LBP patients and their attitudes toward LBP, and which variable best predicts physiotherapists' attitudes toward LBP. Method A self‐administered questionnaire was used to collect the data which included a socio‐demographic section, self‐reports about the work setting, and a clinical experience section. Participants also completed the 15‐item Health Care Providers' Pain and Impairment Relationship Scale (HC‐Pairs) questionnaire. The HC‐Pairs is scored on a 7‐point Likert scale, a high score indicating a stronger belief that pain limits daily function. Results A total of 213 physiotherapists completed the questionnaire. The mean HC‐Pairs score of community‐orthopaedics physiotherapists was significantly lower than that of non community‐orthopaedics physiotherapists (mean 44.02‐ + 9.44 vs 48.69‐ + 10.89, t = −3.29, P < 0.001) indicating that community‐orthopaedics physiotherapists hold a weaker belief that pain limits daily function. Analysis suggests that there is a statistically significant difference in the mean HC‐Pairs scores between the high‐frequency and the low‐frequency group (F = 4.688, P < 0.05) implicating that as physiotherapists experience more frequent encounters with LBP patients, their belief that pain limits daily function of these patients weakens. Work setting is the only variable that predicts the HC‐Pairs scores. Conclusions There is an association between physiotherapists' work setting and clinical experience with LBP patients and their attitudes toward LBP. These findings have implications for future educational programs for physiotherapists and suggest the need to adapt programs to the work setting of physiotherapists and to their level of clinical experience.
There are only a few studies focusing on the content of doctoral dissertations in the field of PT even though academic dissertations are important for shaping a discipline. The aim of this study was to explore and describe a paradigm and criteria for an academic discipline in Nordic doctoral dissertations written by physiotherapists. The study was based on content analysis of the abstracts in 418 doctoral dissertations conducted over three decades. A descriptive and retrospective research approach was used. The results show that the PT dissertations focus on clinical questions within a broad range of PT practise areas. They are mainly applied research studies with a quantitative approach, although qualitative and mixed methods are used. The dissertations are conducted in different academic faculties, however, mainly in medical and health sciences. Theoretical reflection about conceptual, ontological and epistemological issues is scarce. The concept analysis in the Swedish dissertations (n = 219) demonstrates a health- and function-oriented approach to reality. The results of this study indicate that PT as a discipline is clinically oriented and might be guided both by the implicit PT practise paradigm and by various scientific disciplines. Further theoretical reflections and studies about the theory of science in PT are needed.
Contemporary and future physiotherapists are, and will be, presented with challenges different to their forebears. Yet, physiotherapy tends to remain tied to historical ways of seeing the world: these are passed down to generations of physiotherapy graduates. These historical perspectives privilege particular knowledge and skills so that students gain competency for graduation. However, contemporary practice is inherently more complex than the focus on knowledge and skills would have us believe. Professional life requires students to develop the capability to deal with uncertain and diverse futures. This paper argues that physiotherapy needs to think differently about entry-level education; the focus on knowledge and competencies that has been the mainstay in physiotherapy education must now be understood in the context of an education that embraces knowing, doing, being. Two educational frameworks are offered in support of this argument - threshold concepts and ways of thinking and practicing (WTP). Taken together, these ideas can assist physiotherapy to think in fresh ways about disciplinary learning. Threshold concepts and WTP help to understand the nature of a discipline: its behaviors, culture, discourses, and methods. By interrogating the discursive aspects of the discipline, physiotherapy educators will be better placed to provide more relevant preparation for practice.
Few can imagine a world without telephones or televisions; many depend on computers and the internet as part of daily life. Without scientific theory, these developments would not have been possible. In this exceptionally clear and engaging introduction to philosophy of science, James Ladyman explores the philosophical questions that arise when we reflect on the nature of the scientific method and the knowledge it produces.
Scitation is the online home of leading journals and conference proceedings from AIP Publishing and AIP Member Societies
Scitation is the online home of leading journals and conference proceedings from AIP Publishing and AIP Member Societies