David,
Not too challenging at all :) Interesting experiment that you guys
conducted... I don't think I would have the patience nor the time to do U/S
for 18 minutes. I remember a patient said to me once, "the physio I use to
goto put U/S on me while she was picking her pimples."
It has been a good discussion.
Henry***
>From: "RIDDELL, David" <[log in to unmask]>
>Reply-To: - for physiotherapists in education and practice
><[log in to unmask]>
>To: [log in to unmask]
>Subject: Re: ultrasound
>Date: Fri, 24 Aug 2001 08:00:46 +0100
>
>Hi Henry
>
>I was trying to be a bit challenging?! Like you I have spent all my time in
>private albeit somewhat longer and I am aware of the issues you face
>(financial vs professional etc).
>
>My last word on US (I hope). I actually completed a RCT way back in 1991
>for
>my University thesis (which I didn't publish) - too busy/idle? anyway we
>looked at a very specific injury (acute lat lig sprains of the ankle with
>only specific ligs injured + a whole lot of exclusion criteria, time of
>injury within a tight window period, rigorous regime of 5 treatments over a
>7 day period etc etc - it was extremely tightly controlled, dosages
>frequency etc was based on the best available evidence at the time mainly
>work by Dyson and ? (can't remember off the top of my head). We objectively
>measured outcome i.t.o digital goniometer, water displacement and
>subjective
>VAS. Control group got sham otherwise everything else the same.
>
>The EXpt. group improved significantly on two of the three measures and had
>a clinically but not statistically significant improvement on the third.
>HOWEVER the problem was that because dosage was based on an 'accurately
>measured' area using a grid, we found that the average time of insonation
>was in the region of about 18 minutes and that some patients - large gents
>required up to 25 minutes - not very practical!!!
>
>Anyway keep well
>
>Dave Riddell
>
>
>
>
>-----Original Message-----
>From: Henry Tsao [mailto:[log in to unmask]]
>Sent: 23 August 2001 13:38
>To: [log in to unmask]
>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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