Frank,
Thank you for your references. I guess I am not totally against
interferential, and realize that there are studies and people's experience
which show its effectiveness. However, I do have to ask, how do you target
the interferential specific for the spinal nerve?? I think this is the major
problem of electrotherapy - how specific is it for the tissue at fault?? it
is one area where more studies may need to be done in my opinion.
As with your second point regarding giving patients what they want, I
totally agree with you and this study. This is probably why sometimes I
don't try and alter their expectation of what I am about to do - I am not
about to give away 20% improvement in a patient because there is a lack of
evidence, especially in a private practice setting. In saying this, if I
feel a patient is open to new ideas, I may re-educate them and focus more on
manual therapy and giving them home exercises. It really does depend on the
individual patient.
Henry***
>From: Frank Conijn <[log in to unmask]>
>Reply-To: - for physiotherapists in education and practice
><[log in to unmask]>
>To: [log in to unmask]
>Subject: Re: electrotherapy
>Date: Fri, 24 Aug 2001 03:16:02 +0200
>
>Henry,
>
>In April the Archives of Phys. Med. & Rehab. had an article on IF electro.
>The study showed that it speeds up recovery from acute LBP, if it is
>applied
>to the spinal nerve (more than if applied to the painful area). This is
>the link (copy and paste the whole URL into your browser):
>http://www.archives-pmr.org/scripts/om.dll/serve?action=searchDB&searchDBfor
>=art&artType=abs&id=aapmr0820485&nav=abs . It's not that this article all
>of sudden changes everything with respect to the evidence available, but it
>did show a "clinically meaningful reduction in functional disability".
>
>With respect to giving patients what they want: apparently, if a mind is
>positively preconditioned to some therapy, it's not a bad idea:
>http://ipsapp002.lwwonline.com/servlet/GetFileServlet?J=1140&I=135&A=4
>&U=1&T=0 (again, copy and paste the whole URL). I had the impression
>already
>for quite a long time (as well), and finally there's the proof that it can
>make a 20% difference.
>
>Have fun,
>Frank
>
>
>----- Original Message -----
>From: "Henry Tsao" <[log in to unmask]>
>To: <[log in to unmask]>
>Sent: donderdag 23 augustus 2001 14:37
>Subject: Re: ultrasound
>
>
>David,
>
>Sorry I didn't answer your questions... I took it that you were making more
>a comment than a serious question toward myself. I will answer your
>questions now :)
>
> >i Firstly, you didn't anwer my question - what's the evidence like
>on
> >Interferential?
>
>**LIke any electrotherapy, the evidence on the interferential is not very
>good. There was an article in Physiotherapy June 1999/Vol85/No6 p294 - "The
>Mystiqe of Interferential Currents when used to Manage Pain" - which stated
>that with regards to pain relief, "...there is little consistent
>information
>about the different effects of varying dosages. In fact, there is scanty
>proof that it works at all."
>
>Also, in The Clinical Journal of Pain Vol 17 No 1 2001, p33 "
>Nonpharmacological treatments for musculoskeletal pain" (which is an
>article
>I'd recommend all Physiotherapists to read!), it stated that "the evidence
>base to allow us to properly determine the effectiveness of this treatment
>modality is inadequate. Those studies that have been reported do not
>suggest
>significant therapeutic benefit." However, they do state the need for more
>high-quality trials, but found TENS to be more effective than
>interferential
>according to the evidence available.
>
>
> >ii. If the patient has '..been coming in for a long time ..' - have you
> >not
> >considered that perhaps you not doing doing something right and the other
> >physio with the 'tingling machine' was treating symptomatically instead
>of
> >looking for, and correcting the underlying cause(s) of the problem?
>
>**I will answer your question in two parts. Firstly, I have only been a PT
>for the last 1.5 years, and I took over from another Physiotherapist who
>was
>there for 3 years and who built a good reputation in the community. When I
>first started, it was difficult to change your treatment protocol, more
>because the clients did not have as much confidence in you. As I have
>stated
>in previous posts, if the patients do not have confidence in you, why would
>they let you try something different. I remember a number of patients where
>I did not put the interferential on them, and they told my boss that "I did
>not do anything at all." As I said, they have been well trained by the old
>Physiotherapy "way". I even know Physio practices around my area now who
>put
>the interferential and heat pack BEFORE the Physio does anything at all!!!
>You are in marketing terms satisfying consumer demand.
>
>Secondly, I would have to say that when I first graduated, I was thrown
>into
>the deep end of private practice. My boss had a sick wife with CFS, so I
>had
>to look after a practice independently without any prior physio or clinical
>experience. Of course my treatment back then would have been fairly poor,
>but as I gain more experience and confidence, and learn more from physio
>lists such as this one, I gradually reduced the amount of electrotherapy
>used. As well, patients and referring physicians had more confidence in
>what
>I was doing - so I am slowly getting rid off electrotherapy. As much as I
>hate it, I still am forced to use it on certain patients (see next
>question)
>
>
> >iii. Do you always give the patient 'what they want' - if you weren't in
> >private practice would you do this and if not why not? Shouldn't this be
>an
> >appropriate treatment/professional issue not what sounds like a practice
> >income issue?
> >
>
>**I guess I answered part of this question in my previous response. The
>answer is no, I do not usually give the patient what they want, unless they
>have been "trained." I have learnt that yes, you have to be a
>Physiotherapist and practice EBM, but sometimes, you also have to be a
>businessman. I learnt this the hard way once again through some bitter
>experiences. You will always get patients who come in and demand that they
>want this and that done on them. If you go against it, then no matter how
>good a job you do, they will always think you are a bad physio. I think
>this
>is one of the biggest lessons I got out of private practice. As much as I
>hate it, private practice in Australia is about balancing your role as a
>Physiotherapist, the patients expectations and the business side - and
>these
>three do not always go together. Plus it is not my practice, so I have a
>responsibility towards my boss for keeping the clients happy. But if I had
>my own practice, perhaps I may do things differently...
>
> >Alternatively, I need treatment so when next I'm in Oz, I'd like some
> >cocaine as that's what I want!!
>
>**I know the government here are trying hard to resist legalisation of
>cocaine, but they are getting a lot of pressure from different groups. Once
>it becomes legalised, I will let you know :D
>
>I hope I have answered your questions this time.
>
>Henry***
>
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