Mr Cheng,
I spoke to a Taiwanese friend who has spoken to you in the past, and from
what he mentioned, you are undergoing a lot of studies in US therapy(I am
Taiwancese too). From what he has told me, you are a remarkable man, and I
respect you for this.
I understand your points of view, but I guess it is unlikely possible for a
therapist to see a patient 5x a week... you are right, it is not the fault
of electrotherapy, and nobody is saying that. However, most of the time, you
see patients on a maximum of 3x/week, hence electrotherapy won't be
effective enough, and this is the point I am talking about. This is probably
why most physiotherapy students at UQ see no future for electrotherapy, and
hence probably why they despise of it.
Henry***
>From: "Goh Ah Cheng" <[log in to unmask]>
>Reply-To: [log in to unmask]
>To: "Henry Tsao" <[log in to unmask]>
>CC: "epa" <[log in to unmask]>, <[log in to unmask]>
>Subject: Re: THE ELECTROTHERAPY ISSUE
>Date: Sat, 21 Oct 2000 01:35:35 +0900
>
>Dear Henry,
>
>Thank you for reply. I must apologise to you and members of the list if I
>gave the impression that Bruce and I were having a discussion. We weren't.
>But perhaps the two of us can start again....
>Henry:
> > 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.
>Cheng:
>There are 24 references on my web site that relates to clinical studies on
>ultrasound (http://health.shinshu-u.ac.jp/PT/electro/usstudies.htm) From
>the summary table, you can see that for acute injuries, Ultrasound has been
>shown to be effective for acute injuries in only one study by Middlemast
>and
>Chatterjee (1978). The dosage they used was 1.5MHz, 0.5 to 2.0 watt/cm2
>(pulsed) 5X/week. For sub-acute, and chronic injuries, Ultrasound was not
>effective. In the treatment of wounds and ulcers, ultrasound was shown to
>be very effective in quite a few studies.
>However, lets take this further. In the management of pain, there have
>been
>other more effective modalities compared to US. For instance, if you
>looked
>under electrical stimulation for pain modulation
>(http://health.shinshu-u.ac.jp/PT/electro/electrostudies.htm), you will
>find
>several good studies there that demonstrates clinical effectiveness. The
>dosage parameters are also given next to the study. In addition, if you
>looked at Lasers
>(http://health.shinshu-u.ac.jp/PT/electro/laserstudies.htm)
>you'll find an overwhelming majority of the studies show that it does NOT
>work for pain.
>I guess what I am getting at here is that it is pointless to look at a few
>studies randomly and conclude from there that electrotherapy is effective
>or
>ineffective. You would have to go a bit deeper than that in order to do
>the
>subject some justice. I have attempted to do that by putting it on a web
>site. Another member of this list Hamish Ashton ([log in to unmask])
>recently completed a lit review on Ultrasound and wrote in to support its
>use for ulcers but no one has acknowledged his message. (Why are we so
>hung
>up on pain).
>Secondly, as the evidence has shown, you would have to select the
>appropriate modality for the specific clinical effect that you want to
>achieve for your patient. If pain modulation was your goal, the evidence
>suggests that electrical stimulation is far more effective than ultrasound.
>The latter being effective only for acute injuries.
>Thirdly, the whole discussion so far has centred around PAIN and the
>alleviation of pain using electro-modalities. While this is one of the
>benefits of EPA, it is not the ONLY effect we achieve with EPA. EPA covers
>a lot of ground including thermotherapy (SWD, MW, US, IR, etc..),
>cryotherapy, electrotherapy (for pain modulation, muscle re-education, and
>tissue healing), phototherapy (for dermatological conditions),
>mechanotherapy (traction, CPM, intermittent pneumatic pressure), and even
>pharmacotherapy (phonophoresis and iontophoresis). That is a lot of ground
>to cover and any discussion on EPA would be pointless without being
>specific. You can't just look at one or two effects (eg. fibroblasts and
>and leucocytes) and one or two modalities (eg ultrasound) and conclude from
>there that the entire field of EPA is ineffective. This ignores the
>evidence of so many other good studies that have demonstrated clinically
>effective results such as the use of ES for the treatment of incontinence
>(http://health.shinshu-u.ac.jp/PT/electro/electrostudies.htm), the use of
>intermittent pneumatic pressure for oedema
>(http://health.shinshu-u.ac.jp/PT/electro/pressurestudies.htm) , the use of
>US, ES and UV for wound healing, the use of ES and thermotherapy for pain
>modulation, the use of phonophoresis
>(http://health.shinshu-u.ac.jp/PT/electro/phonostudies.htm) and
>iontophoresis (http://health.shinshu-u.ac.jp/PT/electro/iontostudies.htm)
>in
>the treatment of various disorders including pain and inflammation, the use
>of cryotherapy for the treatment of swelling and pain
>(http://health.shinshu-u.ac.jp/PT/electro/cryostudies.htm), the use
>of....... Sure, not all of them were success stories, but not every one of
>them were dismal failures either. If you were to look at the evidence
>across the board, you will find some modalities that have very strong
>evidence for its effectiveness (eg. electrical stimulation for pain and
>wound healing) and some not so strong evidence (eg. ultrasound for pain).
>Conversely, you will also find very strong evidence that shows it is
>INEFFECTIVE (eg. lasers for pain), and some not so strong evidence of
>ineffectiveness (eg. ultrasound for pain). Surely, any school that boasts
>of being an evidence based practice champion should have included this in
>its EPA curriculum. It is not possible to discuss the subject fully with
>just a few emails going back and forth. The web site I created itself
>needs
>more than a few visits just to digest the evidence. It cannot be reduced
>to
>a "postage stamp" size dialogue. Incidentally, we haven't even been able
>to
>discuss other issues such as dosimetry (including frequency of treatment),
>technical competency during its applications (some depts even let patients
>apply the treatment themselves!!), machine reliability (the power output
>from ultrasound has been shown to be unreliable if it is not calibrated
>regularly. That means that many physios are giving US treatment at a
>pre-selected intensity which is not the actual output from the transducer).
>So, while we may be able to demonstrate effectiveness of ultrasound (for
>example) in the treatment of acute pain experimentally, the duplication of
>these same effects in the clinics is difficult to achieve because the dose
>was inappropriate, or the application was sloppy, or the output of the
>ultrasound itself has drifted and readings that you see on your meter isn't
>what is coming out of the transducer. How many of you actually send in
>your
>ultrasound for calibration even once a year??
>
>Henry:
> >
> > 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.
>
>Cheng:
>I have tried to give you information from more than 130 references from my
>web site. If you consider that "a few", then how many is enough?
>
>Henry:
> 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!!
>
>Cheng:
>But isn't this issue separate from clinical effectiveness. If you insist
>on
>treating your patient for 15min at 2X/week, when the evidence says that you
>should be treating the patient for 5X/week (for example), do you blame the
>electromodality or the sloppy application of the modality. The same can be
>said about drugs. If the dosage says take "two pills and call me in the
>morning" and you only took half a pill, would you tell your doctor that the
>medicine was ineffective?
>
>Henry:
> > 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.
>
>Cheng:
>Whether we choose to use EPA or mobs or spray and stretch or whatever
>treatment options we have, doesn't it NOT preclude teaching our patients to
>look after themselves, how to prevent relapses, how to etc..... Just
>because EPA was one of the treatment options does not mean we FORGET how to
>be Physical Therapists like everyone else.
>
>Henry:
> > 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.
>
>Cheng:
>I have no idea why students from UQ despise their EPA so much. Perhaps,
>therein lies the problem.
>
>Regards,
>Cheng
>
_________________________________________________________________________
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.
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|