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PHYSIO  January 2002

PHYSIO January 2002

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Subject:

Re: clicking in the groin?

From:

"Douglas M. White" <[log in to unmask]>

Reply-To:

- for physiotherapists in education and practice <[log in to unmask]>

Date:

Sun, 13 Jan 2002 19:08:20 -0500

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (532 lines)

My question would be why is Ultrasould being used for anything besides the
possible exception of calcific tendonitis of the shoulder??See References
below.Douglas M. White, PT, OCS191 Blue Hills ParkwayMilton, MA
[log in to unmask] [log in to unmask]: Phys Ther
2001 Jul;81(7):1351-8

A review of therapeutic ultrasound: biophysical effects.

Baker KG, Robertson VJ, Duck FA.

Department of Health Science, Faculty of Health, Science, and Technology,
UNITEC, Private Bag 92025, Auckland, New Zealand.

Almost 2 decades ago, it was pointed out that physical therapists tended to
overlook the tenuous nature of the scientific basis for the use of
therapeutic
ultrasound. The purpose of this review is to examine the literature
regarding
the biophysical effects of therapeutic ultrasound to determine whether these
effects may be considered sufficient to provide a reason (biological
rationale)
for the use of insonation for the treatment of people with pain and soft
tissue
injury. This review does not discuss articles that examined the clinical
usefulness of ultrasound (see article by Robertson and Baker titled "A
Review of
Therapeutic Ultrasound: Effectiveness Studies" in this issue). The
frequently
described biophysical effects of ultrasound either do not occur in vivo
under
therapeutic conditions or have not been proven to have a clinical effect
under
these conditions. This review reveals that there is currently insufficient
biophysical evidence to provide a scientific foundation for the clinical use
of
therapeutic ultrasound for the treatment of people with pain and soft tissue
injury.

Publication Types:
Review
Review, Tutorial

PMID: 11444998 [PubMed - indexed for MEDLINE]



2: Phys Ther  2001 Jul;81(7):1339-50

A review of therapeutic ultrasound: effectiveness studies.

Robertson VJ, Baker KG.

School of Physiotherapy, La Trobe University, Bundoora, Victoria 3086,
Australia. [log in to unmask]

BACKGROUND AND PURPOSE: Therapeutic ultrasound is one of the most widely and
frequently used electrophysical agents. Despite over 60 years of clinical
use,
the effectiveness of ultrasound for treating people with pain,
musculoskeletal
injuries, and soft tissue lesions remains questionable. This article
presents a
systematic review of randomized controlled trials (RCTs) in which ultrasound
was
used to treat people with those conditions. Each trial was designed to
investigate the contributions of active and placebo ultrasound to the
patient
outcomes measured. Depending on the condition, ultrasound (active and
placebo)
was used alone or in conjunction with other interventions in a manner
designed
to identify its contribution and distinguish it from those of other
interventions. METHODS: Thirty-five English-language RCTs were published
between
1975 and 1999. Each RCT identified was scrutinized for patient outcomes and
methodological adequacy. RESULTS: Ten of the 35 RCTs were judged to have
acceptable methods using criteria based on those developed by Sackett et al.
Of
these RCTs, the results of 2 trials suggest that therapeutic ultrasound is
more
effective in treating some clinical problems (carpal tunnel syndrome and
calcific tendinitis of the shoulder) than placebo ultrasound, and the
results of
8 trials suggest that it is not. DISCUSSION AND CONCLUSION: There was little
evidence that active therapeutic ultrasound is more effective than placebo
ultrasound for treating people with pain or a range of musculoskeletal
injuries
or for promoting soft tissue healing. The few studies deemed to have
adequate
methods examined a wide range of patient problems. The dosages used in these
studies varied considerably, often for no discernable reason.

Publication Types:
Review
Review, Tutorial

PMID: 11444997 [PubMed - indexed for MEDLINE]

1: Pain  1999 Jun;81(3):257-71

Ultrasound therapy for musculoskeletal disorders: a systematic review.

van der Windt DA, van der Heijden GJ, van den Berg SG, ter Riet G, de Winter
AF,
Bouter LM.

Institute for Research in Extramural Medicine, Faculty of Medicine, Vrije
Universiteit, Amsterdam, The Netherlands. [log in to unmask]

BACKGROUND: Ultrasound therapy is used frequently to reduce pain and related
disability, mainly by physiotherapists. The objective of this review was to
evaluate the effectiveness of ultrasound therapy in the treatment of
musculoskeletal disorders. METHODS: Published reports of randomized clinical
trials investigating the effects of ultrasound therapy on pain, disability
or
range of motion were identified by a systematic search of MEDLINE, EMBASE
and
the Cochrane databases, supplemented with citation tracking. The quality of
methods of all selected publications was assessed systematically by two
independent and 'blinded' reviewers, using ten validity criteria. Data from
the
original publications were used to calculate the differences between groups
for
success rate, pain, disability and range of motion. Statistical pooling was
performed if studies were homogeneous with respect to study populations,
interventions, outcome measures and timing of follow-up. RESULTS: 38 Studies
were included in the review, evaluating the effects of ultrasound therapy
for
lateral epicondylitis (n = 6), shoulder pain (n = 7), degenerative rheumatic
disorders (n = 10), ankle distorsions (n = 4), temporomandibular pain or
myofacial pain (n = 4) and a variety of other disorders (n = 7). In 11 out
of 13
placebo-controlled trials with validity scores of at least five out of ten
points, no evidence of clinically important or statistically significant
results
was found. Statistical pooling was only feasible for placebo-controlled
trials
on lateral epicondylitis, and produced a pooled estimate for the difference
in
success rate of 15% (95% confidence interval -8%-38%). CONCLUSIONS: As yet,
there seems to be little evidence to support the use of ultrasound therapy
in
the treatment of musculoskeletal disorders. The large majority of 13
randomized
placebo-controlled trials with adequate methods did not support the
existence of
clinically important or statistically significant differences in favour of
ultrasound therapy. Nevertheless, our findings for lateral epicondylitis may
warrant further investigation.

Publication Types:
Meta-Analysis

PMID: 10431713 [PubMed - indexed for MEDLINE]





1: Phys Ther  2001 Oct;81(10):1719-30

Philadelphia Panel evidence-based clinical practice guidelines on selected
rehabilitation interventions for shoulder pain.

 Philadelphia Panel.

INTRODUCTION: A structured and rigorous methodology was developed for the
formulation of evidence-based clinical practice guidelines (EBCPGs), then
was
used to develop EBCPGs for selected rehabilitation interventions for the
management of shoulder pain. METHODS: Evidence from randomized controlled
trials
(RCTs) and observational studies was identified and synthesized using
methods
defined by the Cochrane Collaboration that minimize bias by using a
systematic
approach to literature search, study selection, data extraction, and data
synthesis. Meta-analysis was conducted where possible. The strength of
evidence
was graded as level I for RCTs or level II for nonrandomized studies.
DEVELOPING
RECOMMENDATIONS: An expert panel was formed by inviting stakeholder
professional
organizations to nominate a representative. This panel developed a set of
criteria for grading the strength of both the evidence and the
recommendation.
The panel decided that evidence of clinically important benefit (defined as
15%
greater relative to a control based on panel expertise and empiric results)
in
patient-important outcomes was required for a recommendation. Statistical
significance was also required but was insufficient alone. Patient-important
outcomes were decided by consensus as being pain, function, patient global
assessment, quality of life, and return to work, providing that these
outcomes
were assessed with a scale for which measurement reliability and validity
have
been established. VALIDATING THE RECOMMENDATIONS: A feedback survey
questionnaire was sent to 324 practitioners from 6 professional
organizations.
The response rate was 51%. RESULTS: Only 1 positive recommendation of
clinical
benefit was developed. Ultrasound provided clinically important pain relief
relative to a control for patients with calcific tendinitis in the short
term
(less than 2 months). There was good agreement with this recommendation from
practitioners (75%). For several interventions and indications (eg,
thermotherapy, therapeutic exercise, massage, electrical stimulation,
mechanical
traction), there was a lack of evidence regarding efficacy. CONCLUSIONS:
This
methodology of developing EBCPGs provides a structured approach to assessing
the
literature and developing EBCPGs that incorporates clinicians' feedback and
is
widely acceptable to practicing clinicians. Further well-designed RCTs are
warranted regarding the use of several interventions for patients with
shoulder
pain where evidence was insufficient to make recommendations.

Publication Types:
Consensus Development Conference
Guideline
Meta-Analysis
Practice Guideline
Review

PMID: 11589645 [PubMed - indexed for MEDLINE]



2: Phys Ther  2001 Oct;81(10):1701-17

Philadelphia Panel evidence-based clinical practice guidelines on selected
rehabilitation interventions for neck pain.

 Philadelphia Panel.

INTRODUCTION: A structured and rigorous methodology was developed for the
formulation of evidence-based clinical practice guidelines (EBCPGs), then
was
used to develop EBCPGs for selected rehabilitation interventions for the
management of neck pain. METHODS: Evidence from randomized controlled trials
(RCTs) and observational studies was identified and synthesized using
methods
defined by the Cochrane Collaboration that minimize bias by using a
systematic
approach to literature search, study selection, data extraction, and data
synthesis. Meta-analysis was conducted where possible. The strength of
evidence
was graded as level I for RCTs or level II for nonrandomized studies.
DEVELOPING
RECOMMENDATIONS: An expert panel was formed by inviting stakeholder
professional
organizations to nominate a representative. This panel developed a set of
criteria for grading the strength of both the evidence and the
recommendation.
The panel decided that evidence of clinically important benefit (defined as
15%
greater relative to a control based on panel expertise and empiric results)
in
patient-important outcomes was required for a recommendation. Statistical
significance was also required but was insufficient alone. Patient-important
outcomes were decided by consensus as being pain, function, patient global
assessment, quality of life, and return to work, providing that these
outcomes
were assessed with a scale for which measurement reliability and validity
have
been established. VALIDATING THE RECOMMENDATIONS: A feedback survey
questionnaire was sent to 324 practitioners from 6 professional
organizations.
The response rate was 51%. RESULTS: For neck pain, therapeutic exercises
were
the only intervention with clinically important benefit relative to a
control
(grade A for pain and function, grade B for patient global assessment).
There
was good agreement with this recommendation from practitioners (93%). For
several interventions and indications (eg, thermotherapy, therapeutic
ultrasound, massage, electrical stimulation), there was a lack of evidence
regarding efficacy. CONCLUSIONS: This methodology of developing EBCPGs
provides
a structured approach to assessing the literature and developing guidelines
that
incorporates clinicians' feedback and is widely acceptable to practicing
clinicians. Further well-designed RCTs are warranted regarding the use of
several interventions for patients with neck pain where evidence was
insufficient to make recommendations.

Publication Types:
Consensus Development Conference
Guideline
Meta-Analysis
Practice Guideline
Review

PMID: 11589644 [PubMed - indexed for MEDLINE]



3: Phys Ther  2001 Oct;81(10):1675-700

Philadelphia Panel evidence-based clinical practice guidelines on selected
rehabilitation interventions for knee pain.

 Philadelphia Panel.

INTRODUCTION: A structured and rigorous methodology was developed for the
formulation of evidence-based clinical practice guidelines (EBCPGs), then
was
used to develop EBCPGs for selected rehabilitation interventions for the
management of knee pain. METHODS: Evidence from randomized controlled trials
(RCTs) and observational studies were identified and synthesized using
methods
defined by the Cochrane Collaboration that minimize bias by using a
systematic
approach to literature search, study selection, data extraction, and data
synthesis. Meta-analysis was conducted where possible. The strength of
evidence
was graded as level I for RCTs or level II for nonrandomized studies.
DEVELOPING
RECOMMENDATIONS: An expert panel was formed by inviting stakeholder
professional
organizations to nominate a representative. This panel developed a set of
criteria for grading the strength of both the evidence and the
recommendation.
The panel decided that evidence of clinically important benefit (defined as
15%
greater relative to a control based on panel expertise and empiric results)
in
patient-important outcomes was required for a recommendation. Statistical
significance was also required but was insufficient alone. Patient-important
outcomes were decided by consensus as being pain, function, patient global
assessment, quality of life, and return to work, providing that these
outcomes
were assessed with a scale for which measurement reliability and validity
have
been established. VALIDATING THE RECOMMENDATIONS: A feedback survey
questionnaire was sent to 324 practitioners from 6 professional
organizations.
The response rate was 51%. RESULTS: Two positive recommendations of clinical
benefit were developed: (1) transcutaneous electrical nerve stimulation
(TENS)
and therapeutic exercises were beneficial for knee osteoarthritis, and (2)
there
was good agreement with these recommendations from practitioners (73% for
TENS,
98% for exercises). For several interventions and indications (eg,
thermotherapy, therapeutic ultrasound, massage, electrical stimulation),
there
was a lack of evidence regarding efficacy. CONCLUSIONS: This methodology of
developing EBCPGs provides a structured approach to assessing the literature
and
developing EBCPGs that incorporates clinicians' feedback and is widely
acceptable to practicing clinicians. Further well-designed RCTs are
warranted
regarding the use of several interventions for patients with knee pain where
evidence was insufficient to make recommendations.

Publication Types:
Consensus Development Conference
Guideline
Meta-Analysis
Practice Guideline
Review

PMID: 11589643 [PubMed - indexed for MEDLINE]



4: Phys Ther  2001 Oct;81(10):1641-74

Philadelphia Panel evidence-based clinical practice guidelines on selected
rehabilitation interventions for low back pain.

 Philadelphia Panel.

INTRODUCTION: A structured and rigorous methodology was developed for the
formulation of evidence-based clinical practice guidelines (EBCPGs), then
was
used to develop EBCPGs for selected rehabilitation interventions for the
management of low back pain. METHODS: Evidence from randomized controlled
trials
(RCTs) and observational studies was identified and synthesized using
methods
defined by the Cochrane Collaboration that minimize bias by using a
systematic
approach to literature search, study selection, data extraction, and data
synthesis. Meta-analysis was conducted where possible. The strength of
evidence
was graded as level I for RCTs or level II for nonrandomized studies.
DEVELOPING
RECOMMENDATIONS: An expert panel was formed by inviting stakeholder
professional
organizations to nominate a representative. This panel developed a set of
criteria for grading the strength of both the evidence and the
recommendation.
The panel decided that evidence of clinically important benefit (defined as
15%
greater relative to a control based on panel expertise and empiric results)
in
patient-important outcomes was required for a recommendation. Statistical
significance was also required, but was insufficient alone.
Patient-important
outcomes were decided by consensus as being pain, function, patient global
assessment, quality of life, and return to work, providing that these
outcomes
were assessed with a scale for which measurement reliability and validity
have
been established. VALIDATING THE RECOMMENDATIONS: A feedback survey
questionnaire was sent to 324 practitioners from 6 professional
organizations.
The response rate was 51%. RESULTS: Four positive recommendations of
clinical
benefit were developed. Therapeutic exercises were found to be beneficial
for
chronic, subacute, and postsurgery low back pain. Continuation of normal
activities was the only intervention with beneficial effects for acute low
back
pain. These recommendations were mainly in agreement with previous EBCPGs,
although some were not covered by other EBCPGs. There was wide agreement
with
these recommendations from practitioners (greater than 85%). For several
interventions and indications (eg, thermotherapy, therapeutic ultrasound,
massage, electrical stimulation), there was a lack of evidence regarding
efficacy. CONCLUSIONS: This methodology of developing EBCPGs provides a
structured approach to assessing the literature and developing guidelines
that
incorporates clinicians' feedback and is widely acceptable to practicing
clinicians. Further well-designed RCTs are warranted regarding the use of
several interventions for patients with low back pain where evidence was
insufficient to make recommendations.

Publication Types:
Consensus Development Conference
Guideline
Meta-Analysis
Practice Guideline
Review

PMID: 11589642 [PubMed - indexed for MEDLINE]




----- Original Message -----
From: "Owen Sant' Angelo" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, January 13, 2002 3:18 PM
Subject: Re: [PHYSIO] clicking in the groin?


| Hi,
|
| why wouldn't u/s be used for the internal type?
|
| Owen Sant' Angelo
| PT
| Malta
|
| -----Original Message-----
| From: - for physiotherapists in education and practice
| [mailto:[log in to unmask]]On Behalf Of Sergio Velasquez Velez
| Sent: 13 January 2002 16:09
| To: [log in to unmask]
| Subject: Re: clicking in the groin?
|
|
| Dear Henry and All:
| Good comments from Alison and Tom!
| Another compromise you could get checked is the Snapping Hip Syndrome.
| Remember can be External ( caused by the Iliotibial Band popping over the
| greater trochanter or Internal ( caused by the Iliopsoas Tendon snapping
| over the Iliopectineal Eminence).
| The External type is most common and is treated with ultrasound,
stretching,
| NSAIDS, and sometimes with a corticosteroid injection.
| The Internal type is less common and causes more medial pain without
greater
| trochanter tenderness. Tretment is stretching, NSAIDs, corticosteroid
| injection and surgical intervention if pain persist.
| Intraarticular causes of Snapping Hip include Synovial Chondromatosis,
loose
| Bodies from trauma, or Osteochondritis Dissecans, Osteocartilaginous
| Exostoses, Acetabular Labral Tear, or Inverted Labrum.
| Magnetic Resonance Imaging or sometimes Hip arthroscopy can help to make
the
| Diagnosis.
| Personally I have had 2 Soccer Professional Players with this condition.
| Best regards,
| Sergio Velasquez V.
| Physical Therapy, Medellin,Colombia.
| ----- Original Message -----
| From: "Alison Dakin" <[log in to unmask]>
| To: <[log in to unmask]>
| Sent: Sunday, January 13, 2002 3:56 AM
| Subject: Re: clicking in the groin?
|
|
| > Henry
| > Another thing you could get checked out is his symphysis pubis. I'm no
| > expert on groin problems but one of my colleagues who works in sports
| > medicine is trying to write up oour sports med. clinics review of about
| 120
| > so called groin strains and there are an amazing arrray of problems.
Many
| > are early arthritic hips, but some are symphysis pubis problems, few are
| > true adductor strains!
| >
| > Just another thought.
| > ----- Original Message -----
| > From: "Henry Tsao" <[log in to unmask]>
| > To: <[log in to unmask]>
| > Sent: Saturday, January 12, 2002 10:19 PM
| > Subject: Re: clicking in the groin?
| >
| >
| > > Tom and Sergio,
| > >
| > > Thank you for your feedback. I shall try some of the mentioned
| techniques
| > on
| > > Monday.
| > >
| > > From a hot day in Brisbane,
| > > Henry***
| > >
| > >
| > > _________________________________________________________________
| > > Get your FREE download of MSN Explorer at
| > http://explorer.msn.com/intl.asp.
| > >

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