ABSTRACT
In today’s healthcare systems, physiotherapy is increasingly delivered in fluid and dynamic community contexts. Such environments challenge the ‘hierarchy of evidence’ in the current paradigm of evidence-based practice. We argue that despite highly controlled clinical trials frequently being inappropriate in these contexts, they are still seen as the desired standard of evidence. Faith in this paradigm may consequently jeopardize the development of ‘evidence-based’ rationales for the funding of services. We use the multifactorial example of 24-hour postural care to emphasize the need for a different approach. We explore scenarios where complex care plans function in connection with multiple and intricate systems. To explore these non-linear and symbiotic relationships of systems, and reductionism of viewing ‘things’ rather than ‘processes’, we look to applied microbiology. We relate 24-hour postural care to a place where intricate processes unfold over 24 hours - the sourdough microenvironment of an artisan bakery. To guide these connections, we draw on processual ontology of biology and argue that a shift in how we think about biological processes can provide valuable insights into the complexities of physiotherapy interventions. We use our reflections on concepts from process philosophy to emphasize the value of studying the fluid and dynamic interconnections between different systems to improve understanding and delivery of physiotherapy interventions. We highlight the necessity of broadening the nature of evidence required to make a case for funding of a community-based service or intervention.
