Save Physiotherapy fees - but don't diagnose yourself

Therapeutic ultrasound device for home use

The newest gadget on the market is actually one of the oldest EPA in the business - therapeutic Ultrasound (US). 

A small portable ultrasound machine is now available for purchase by the public from some pharmacies and the net. With the costs of healthcare rising it is no wonder we see promoters of this device suggesting that home use of ultrasound for muscular aches and strains will save on physiotherapy fees.

What worries me is that people will not seek professional diagnosis at all. That sort of shortcut carries real risks of misdiagnosis and/or wrong treatment. For example, someone may apply the ultrasound  over a stress fracture, thinking the problem is shin splints. The consequence is more costly, and longer rather than shorter, recovery times.

It is reasonable to be concerned by the assumptions and misleading use of language used to promote sales of this potentially useful, if not very sturdy, ultrasound machine.

No one would decry the rights of people to have daily treatment when indicated. This device is the first to offer an affordable option for daily ultrasound therapy in the home. However....

FOR MAXIMUM BENEFIT most people need to

1. be shown exactly how to hold and move the device over the area of injury
2. have the initial dose prescribed by a professional
3. be advised whether or not the dose should be altered as the condition changes
4. know how to add other healing activities, (ice or heat, massage, rest or exercise) into a complete home treatment program.

PLEASE don't give your local health professional (chiropractor, osteopath, physio, doctor) the swerve. FOR BEST RESULTS get the correct diagnosis and ask for a treatment plan from a qualified health professional first. Good therapists will be delighted to show you how to use the home ultrasound device safely and effectively.

Yea, David Draper! Go, the Americans

Happy New Year. Your correspondent perceives most EPA research, and particularly ultrasound dose studies, has a certain polarity (ahem). The British tend to be the conservatives, focusing on athermal effects and potential to stimulate healing. The Americans seem to be more interested with thermal doses and tissue temperatures. As you'd expect, physio students are exhorted to avoid any potentially unsafe applications and so the English model of low dose applications feature in their training and lab practice. How gratifying to find A Prof David Draper's case series (6 patients) where therapeutic ultrasound (3 MHz, 1.4 W/cm^2, 6 minutes) heats adaptively shortened connective tissues of the wrist joint capsule so that manual joint glides and passive mobilizations succeed in restoring active and passive range. The reference is:

Draper, D.. (2010). Ultrasound and Joint Mobilizations for Achieving Normal Wrist Range of Motion After Injury or Surgery: A Case Series. Journal of Athletic Training, 45(5), 486-491.  Retrieved January 3, 2011, from Research Library. (Document ID: 2147735161).

This article is an interesting read and I won't critique it or reiterate his data here. What a find! Common sense and sound clinical reasoning prevails. 

David is a prolific EPA researcher and co-author of a useful textbook (illustrated) "Therapeutic Modalities the Art and Science".

International Interest in EPA

From my previous posts you must be getting the idea that the safe and effective application of EPA is a topic of interest in physiotherapy schools around the globe. Did you know that there is an International Society for Electrophysical Agents in Physical Therapy? Information about ISEPAPT is found in the World Confederation for Physical Therapists (WCPT) site. A lovely photograph of the founding members can be seen on the relevant page in Prof Watson's site. Griffith students should recognise a familiar face - not yours truly, but my valued colleague and mentor, Dr Liisa Laakso.

Also, please note that the conference of the WCPT is on in Amsterdam in the middle of 2011. This is a special event occurring only every 4 years. It will be a huge event and the perfect opportunity for physiotherapists from round the world to meet,  and build networks of support for our research and teaching interests. Students can obtain insights into these global connections just by browsing the websites I have linked here.

Many many thanks to Prof Watson

So any thanks must go to Tim Watson for his excellent EPA website. Many of my previous students have found this site to be the most useful study aid. My pre-clinical students (who must gain competencies with EPA very early in their program) find that a good read here provides great insights into the way they as professionals should approach the EPA literature and reason through to safe and effective applications. Tim's website is such a useful resource, being current and constantly expanding, it can be tempting for individuals to do a little 'cut and paste' (e.g. into an assignment) without citing the source. I have found instances where commercial sites present uncited material from Tim's pages. Heed the pleas of the author to do the right thing and acknowledge him whenever necessary. The website is a work of vast personal dedication and blatant copying is clearly stealing. 

Thanks to Dr Shea Palmer

I have just discovered the authorstream.com site and the lectures on central EPA topics (Heat and Cold , Shortwave diathermy) which should be very useful for my students. Thank you, Dr Shea Palmer and  Mr Chee-Wee Tan, for publishing powerpoint slides with such a cogent narration. Hopefully more EPA topics will appear in the near future. 

The swing of the pendulum

Cath Young is a physiotherapist who currently teaches the safe and effective application of electrophysical agents (EPA) in the School of Physiotherapy and Exercise Science at Griffith University on the Gold Coast, Australia.
I began my professional life in an era when the bells and whistles of various machines (ultrasound especially) still had a strong placebo effect and conservative referring doctors did not send patients to alternative practitioners. A reaction to those dreary days of medical referrals asking for "heat and exercises three times per week for three weeks" incited a comprehensive swing against the use of EPA, especially in sports and musculo-skeletal health care. And rightly so. However that swing really represented the turn against the ad hoc treatment of symptoms, rather than a reasoned and evidence based treatment of pathologies and physical syndromes. Now there is movement back to the middle ground. Plenty of highly qualified and skilled Physiotherapists cheerfully admit that the trend to leave EPA on the shelf may be short-changing the patient.