To Mr Cheng, Bruce, and others who are interested in this contraversial
field of electrotherapy:
I have been following the debate recently between the EPA and Bruce, and
since I started this whole contraversial debate, I thought I might go and
have a look a the latest literature on electrotherapy. I don't believe in
personal attacks, and think that physiotherapists should be able to make up
their minds on the issue.
Before I go on, I will just explain. I work in a busy private practice where
we allocate 30 min. roughly per patient. I do use US on trigger points after
acupressure, and Likon on the sympathetic nervous system/psoas (especially
in chronic fatigue and fibromyalgia patients) to reduce its activity, but I
don't use any electro for any other reason unless the patient themselves
request it (and let's face it, I get old clients who come in and just want
to be mob'ed, US'ed and IFT'ed... and that is their choice!!).
I found an interesting article the other day in the Pain journal on the
effectiveness of ultrasound therapy on musculoskeletal pain (Pain 81, 1999
257-271). It basically evaluated the use of US, and looked at the existing
research on the topic. They basically concluded that for lateral
epicondylitis, soft tissue shoulder disorders, deegn rheumatic disorders,
ankle distorsions and TMJ disorders, US showed no significant clinical
effect. Even when they combined US with exercise therapy, there was
clinically important or statistically significant differences in favour of
US (which I was surprised to read, as we always thought that US was
effective only when it is used as an adjunct!!). Even though this does not
totally rule out the uselessness of US therapy, it definitely has some
strong gound to stand on!
On the contrary, I found in the Am J of Physical Medicine and Rehab(79, 1,
p48-52, 2000) an article that looked at the use of US, dry needle, and
stretches of myofascial trigger points in the Upper Trap muscles. They found
that US combined with stretches and dry needle combined with stretches
produced significant results compared to simply stretching alone. However,
there was no difference between dry needle and the use of US in combination
with stretches.
I find it interesting that even though Mr Cheng has noted a few articles
that claim to have clinical evidence of electrotherapy, most of the
literature out there disproves the effectiveness of electrotherapy, and
these should not be ignored. However, this issue will still continue to be
contraversial, the research will go on, and physiotherapists will form their
own opinions of what electro to use. Despite this, I support Bruce's
statement that time and cost is a big factor in this, and should not be
ignored. Unless we are in the field of sport physio and see athletes 3x a
day, 5x a week, I don't see the point of 15min/2x/week - how much difference
is it going to make because that is less than 1% of their week's time!!
Emphasis in this case should be on teaching the patients ultimately how to
look after themselves thus preventing future injury. Most people want to get
better, but also want to know how to keep themselves better, and
electrotherapy does not do this.
Going through an undergraduate degree whereby electrotherapy was focused so
much and yet despised by most students(including myself), I am not for or
against electrotherapy. However, I believe (and this is only my opinion)
that unless there is more research for the efficacy of electrotherapy, not
too many future physiotherapists will include it in their treatment regime.
Henry***
>From: "Goh Ah Cheng" <[log in to unmask]>
>Reply-To: "Goh Ah Cheng" <[log in to unmask]>
>To: <[log in to unmask]>, <[log in to unmask]>
>Subject: Fw: EPA and evidence based practice
>Date: Thu, 19 Oct 2000 18:18:00 +0900
>
>Dear Fellow EPA and PHYSIO Mail-list members,
>
>Below is the reply from Bruce. He has chosen to reply to me directly
>instead of the list, so I am doing him a favour by forwarding it to the
>both
>lists (It must have been an oversight on his part.... perhaps due to
>another
>hard day at work).
>You may want to know that I, Panos and the entire academic community have
>been dismissed by Bruce as unworthy of providing evidence for EPA (or any
>subject for that matter) because WE LEFT THE CLINIC. I am not even going
>to
>respond to this.....
>Secondly, the scientific method has also been denounced as being
>inappropriate for any discussion on evidence based practice (I assume not
>only for EPA, but for our entire base of knowledge!!). Am I missing out on
>something here??
>Thirdly, EPA can be dismissed by all of us from this day henceforth because
>it has been around for the past 50 years and the world was not impressed!!
>I must have missed out when everyone was out there casting their votes.
>Fourthly, God is dead.
>And finally, any discussion that goes contrary to Bruce's point of view is
>immature, incurs opportunity costs and is a waste of taxpayers dollars.
>That is the FINAL WORD, according to Bruce, Chapter 4, Verse Sick (I mean,
>Six).
>Now if you'll excuse me, I have to go look for another God.
>Completey Devastated,
>Cheng
>
>----- Original Message -----
>From: Bruce Gray <[log in to unmask]>
>To: <[log in to unmask]>
>Sent: Thursday, October 19, 2000 5:46 PM
>Subject: Re: EPA and evidence based practice
>
>
> > Hi Gohac
> >
> > On this website, I have found the greatest support for electrotherapy
>comes from academics. I have no idea how much clinical experience they draw
>on, or why they left the clinic.
> > These critics, esp yourself and Panos, seem to make a lot of time to
>reply
>with verbose highbrow sarcasm, using one or two papers here and there to
>give your point invincible Truth status.
> > As anyone who has read knows, the scientific method does not deal in
>deduced ultimate truths, instead it induces enough evidence for a consensus
>to be reached by field peers.
> >
> > That electrotherapy has been around for 50 years and not wowed the world
>with its superior healing powers let alone drawn together scientific peer
>consensus is enough for me to burst the bubble on its overinflated cult
>following.
> >
> > Let's face it guys, your God is dead.
> >
> > And please show some maturity by recognising the opportunity costs of
>continuing this argument. Anything I wanted to say has been said. And I
>assume the same for yourselves. Let it rest at that, and get on with doing
>something more productive with tax payers' dollars.
> >
> >
> > _______________________________________________________________________
> >
> > Free Unlimited Internet Access! Try it now!
> > http://www.zdnet.com/downloads/altavista/index.html
> >
> > _______________________________________________________________________
> >
> >
>
_________________________________________________________________________
Get Your Private, Free E-mail from MSN Hotmail at http://www.hotmail.com.
Share information about yourself, create your own public profile at
http://profiles.msn.com.
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|