A national study of the availability and use of electrophysical agents by Australian physiotherapists

Evaluation of the reliability and quality of YouTube videos as a source of information for transcutaneous electrical nerve stimulation

Background

YouTube plays an influential role in disseminating health-related information in the digital age. This study aimed to evaluate YouTube videos on transcutaneous electrical nerve stimulation (TENS) in terms of their information value and quality.

Methods

In this descriptive study, we ranked the first 100 videos that met the inclusion criteria using the search term "transcutaneous electrical nerve stimulation" on October 30, 2022. These videos were classified according to the number of views, likes, dislikes, comments, duration, popularity and content categories. Reliability, quality, and accuracy of the videos were assessed using the Journal of American Medical Association (JAMA) Benchmark Criteria and Modified DISCERN Questionnaire and Global Quality Score (GQS). Video popularity were calculated by the Video Power Index (VPI).

Results

Based on the GQS results, we found that 59, 27, and 14 videos had low, intermediate, and high quality, respectively. In addition, based on the JAMA results, 79 and 21 videos had poor and high reliability, respectively. No statistically significant difference was found between the JAMA, modified DISCERN and GQS scores in terms of the sources of videos (p = 0.226, p = 0.115, p = 0.812). Notably, there was a weak positive correlation between the JAMA scores and the number of views (r = 0.204, p = 0.041).

Conclusion

According to our study results, most YouTube videos on TENS were of low quality and reliability. Additionally, most videos were uploaded from sources created by doctors; the most frequently found content was about the TENS procedure, and content on complications of the procedure became less frequent as the videos became more recent. In particular, it was found that videos uploaded by academics have longer duration. It has been found that reliable videos with high JAMA scores also have high number of views. Accordingly, it can be concluded that videos with higher quality and more reliability that are created by healthcare providers will be more useful for patients seeking information about TENS.

Physiotherapists' Understanding of Shortwave Diathermy Contraindications: A Questionnaire Survey

Purpose

It is known that electromagnetic fields and heat generated by shortwave diathermy (SWD) can have adverse effects on living tissue. The purpose of this research is to evaluate Jordanian physiotherapists' knowledge of pulsed and continuous SWD contraindications. And investigate the potential contraindications about which Jordanian physiotherapists may have limited knowledge.

Subjects and Methods

This cross-sectional study investigates Jordanian physiotherapists' knowledge of SWD contraindications. In 38 private and public hospitals, a self-administered questionnaire survey was carried out. Participants were asked to classify 32 conditions as "always, sometime, or never" contraindicated or "I do not know". Participants are physiotherapists with two or more years of postgraduate experience. Two forms comprised the survey. The first consisted of assessing their reaction to the contraindications of pulsed shortwave diathermy (PSWD), while the second consisted of continuous shortwave diathermy (CSWD).

Results

Approximately 270 physiotherapists were eligible to participate in this investigation. Only 150 questionnaires were distributed to the therapists who agreed to the study. One hundred twenty-eight were returned for an average response rate of 85.3% (128/150). Respondents had good agreement about using SWD for cardiovascular condition, however, 24 respondents (19%) thought PSWD can be used over venous thrombosis. Only 64% of the respondents was aware that pacemakers are contraindicated for PSWD. Approximately 14% to 32% seem unaware that tuberculosis and osteomyelitis are contraindicated for both CSWD and PSWD. About 21% to 28% have been unaware that the use of PSWD is contraindicated for specialized tissues (eg, eyes, gonads, or malignant tissues) and 29% during pregnancy.

Conclusion

Jordanian physiotherapists generally agreed on the widely acknowledged contraindications of CSWD for specific conditions. However, there was considerable uncertainty among Jordanian physical therapists about the contraindications of PSWD. This discrepancy highlights the need to improve physiotherapist awareness and for more fact-based research to the contraindication of SWD modality.

A Systematic Review and Meta-analysis Investigating the Pain-Relieving Effect of Interferential Current on Musculoskeletal Pain

BACKGROUND

Interferential current is one of the most common electrotherapeutic modalities used in the treatment of painful conditions. Patients seeking medical help to reduce their musculoskeletal pain can be treated using interferential current.

OBJECTIVE

The current review aimed to analyze the recently available information regarding the efficacy of interferential current in alleviating the pain of musculoskeletal origin.

METHODS

This study used Scopus, CINAHL, Cochrane Library, Web of Science, MEDLINE, Embase, and EBSCOas as data sources. The initial selection of the studies, thorough assessment of the full articles, and extraction of the necessary study characteristics were carried out by two independent reviewers. Another two independent reviewers assessed the methodological quality of each included trial against 39 criteria. These criteria were integrated from several popular scales. Pain intensity-measured using the visual analog scale, numeric pain rating scale, or McGill Pain Questionnaire-was the outcome of interest.

RESULTS

This review included 35 trials of variable methodological quality from which 19 trials were selected for the meta-analysis. In general, interferential current alone versus placebo demonstrated a significant pain-relieving effect. On the other hand, interferential current showed no significant difference when added to standard treatment compared with placebo plus standard treatment or standard treatment alone. Similarly, interferential current showed no significant difference when compared with other single interventions (laser, transcutaneous electrical nerve stimulation, cryotherapy).

CONCLUSIONS

Interferential current alone is better than placebo at discharge. However, the low number of studies raises suspicions about this conclusion. Interferential current alone or added to other interventions is not more effective than comparative treatments in relieving musculoskeletal pain.

Effects of Therapeutic Ultrasound on Growth Plates: A Systematic Review

PURPOSE

The aim of this systematic review was to evaluate studies reporting on the effects of therapeutic ultrasound on the physis.

SUMMARY OF KEY POINTS

Eight studies were included in the final analysis, all of which were animal studies. At higher doses, studies found skin and bone necrosis and inhibition of growth, while in lower doses some studies found that ultrasound had a transient stimulatory effect on growth, increased thickness of the hypertrophic zone, and increased thickness of the whole growth plate. Overall, experimental evidence in animal models suggests that therapeutic ultrasound, even at low doses, might induce microscopic changes to the histology of the growth plate.

CONCLUSION

While we found no reports of growth disturbance in humans, given the histological changes found in animal studies, the current limited literature seems to support the recommendation that the application of therapeutic ultrasound around the physis should be avoided.

Changes in availability and usage of electrophysical agents by physical therapists: a 5 year longitudinal follow-up study

[Purpose] There have been concerns that the availability and usage of electrophysical agents have decreased, based on data from cross-sectional surveys. The aim of this study was to conduct the first five-year follow-up longitudinal survey to determine the changes in the availability and usage of electrophysical agents in Nagano Prefecture, Japan. [Participants and Methods] This longitudinal observational study employed the same postal questionnaire survey of practicing clinicians in 2014 and 2019. A total of 22 modalities had been selected for inclusion in the questionnaire based on what is used in clinical facilities and hospitals. [Results] The response rate was 71% and 63% for 2014 and 2019, respectively. The modalities that were high in availability and usage for both 2014 and 2019 were hot packs, ultrasound, cryotherapy and low frequency. While most modalities demonstrated a decreased trend in usage, electrical stimulation devices increased from 2014 to 2019. The results also demonstrated that usage was affected by gender (males greater than females), years of experience (older greater than younger), qualifications (diplomas greater than degrees), and confidence (confident greater than non-confident). [Conclusion] Our results may assist educators with designing educational curricula that is consistent with the needs of clinicians.

Resolving Long-Standing Uncertainty about the Clinical Efficacy of Transcutaneous Electrical Nerve Stimulation (TENS) to Relieve Pain: A Comprehensive Review of Factors Influencing Outcome

Pain is managed using a biopsychosocial approach and pharmacological and non-pharmacological treatments. Transcutaneous electrical nerve stimulation (TENS) is a technique whereby pulsed electrical currents are administered through the intact surface of the skin with the intention of alleviating pain, akin to 'electrically rubbing pain away'. Despite over 50 years of published research, uncertainty about the clinical efficacy of TENS remains. The purpose of this comprehensive review is to critically appraise clinical research on TENS to inform future strategies to resolve the 'efficacy-impasse'. The principles and practices of TENS are described to provide context for readers unfamiliar with TENS treatment. The findings of systematic reviews evaluating TENS are described from a historical perspective to provide context for a critical evaluation of factors influencing the outcomes of randomized controlled trials (RCTs); including sample populations, outcome measures, TENS techniques, and comparator interventions. Three possibilities are offered to resolve the impasse. Firstly, to conduct large multi-centered RCTs using an enriched enrolment with randomized withdrawal design, that incorporates a 'run-in phase' to screen for potential TENS responders and to optimise TENS treatment according to individual need. Secondly, to meta-analyze published RCT data, irrespective of type of pain, to determine whether TENS reduces the intensity of pain during stimulation, and to include a detailed assessment of levels of certainty and precision. Thirdly, to concede that it may be impossible to determine efficacy due to insurmountable methodological, logistical and financial challenges. The consequences to clinicians, policy makers and funders of this third scenario are discussed. I argue that patients will continue to use TENS irrespective of the views of clinicians, policy makers, funders or guideline panel recommendations, because TENS is readily available without prescription; TENS generates a pleasant sensory experience that is similar to easing pain using warming and cooling techniques; and technological developments such as smart wearable TENS devices will improve usability in the future. Thus, research is needed on how best to integrate TENS into existing pain management strategies by analyzing data of TENS usage by expert-patients in real-world settings.

Electrophysical agents in clinical practice of orthopedic and sports physical therapists in Brazil

ABSTRACT Studies have described the use of electrophysical agents (EPA) by physical therapists worldwide. However, the use of EPA by Brazilian physical therapists remains undetermined. This study aims to describe the availability, use, and perception about EPA by orthopedic and sports physical therapists in Brazil. Professionals of the area were invited to answer an online questionnaire. Demographic data and information regarding the availability, use and perception about EPA in their current clinical practice were asked. Out of 376 physical therapists included in this study, 89% declared to use EPA in clinical practice. Sensory electrotherapy with pulsed current (TENS), therapeutic ultrasound, excitomotor electrotherapy with pulsed current (FES/NMES), and cryotherapy are available for more than 3/4 of interviewees. Scientific articles and clinical experience, respectively, are the most influential factors for the choice of EPA. Ultrasound is the most frequently used EPA, followed by TENS, cryotherapy, photobiomodulation, hot packs, and FES/NMES. The top-five most useful EPA in clinical practice chosen by physical therapists are: (1) ultrasound; (2) photobiomodulation; (3) TENS; (4) cryotherapy; and (5) FES/NMES. In conclusion, EPA are widely used by orthopedic and sports physical therapists in Brazil. Therapeutic ultrasound, TENS, FES/NMES, photobiomodulation, cryotherapy, and hot packs are the most used EPA in clinical practice of these physiotherapists.

High-energy dose of therapeutic ultrasound in the treatment of patellar tendinopathy: protocol of a randomized placebo-controlled clinical trial

BACKGROUND

Patellar tendinopathy is an extremely debilitating condition and its treatment usually requires a combination of clinical approaches. Therapeutic ultrasound (TUS) is one of the most available electrophysical agent in rehabilitation settings; however, there is also a lack of high-quality studies that test different dosimetric aspects of TUS. Thus, the purpose of this study is to evaluate the short-, medium-, and long-term effects of the combination of high-energy TUS with a rehabilitation program for patellar tendinopathy.

METHODS

This will be a randomized, placebo-controlled trial with blinding of patients, assessors, and therapist. The setting is an outpatient physical therapy clinic. We will recruit 66 participants (male and female) aged between 18 and 40 years and presenting with patellar tendinopathy. A treatment combining high-energy dose TUS and a rehabilitation program for patellar tendinopathy will be delivered twice a week for 8 weeks. The control group will receive the same treatment, but with a placebo TUS. The effectiveness of the intervention will be measured at the beginning (baseline), midpoint (4 weeks), and end of treatment (8 weeks), as well as at 3- and 6-months post-treatment. Primary outcomes will be pain intensity (visual analogue scale, VAS), and VISA-P questionnaire and primary time points will be baseline (T0) and the end of the program (T2). Also, IPAQ-short form questionnaire, muscle strength (manual dynamometry), 2D kinematics, pain pressure threshold (PPT) algometry, thermography, and magnetic resonance imaging (MRI) will be collected.

DISCUSSION

TUS will be applied in an attempt to enhance the results obtained with the rehabilitation program proposed in this study, as well as stimulate some repair responses in individuals undergoing treatment for patellar tendinopathy, which in turn may optimize and improve treatment programs for patellar tendinopathy as well as to establish new guidelines for the application of TUS.

TRIAL REGISTRATION

This study was prospectively registered at April-3rd-2018 and updated at September-1st-2019 in the Brazilian Registry of Clinical Trials (REBEC) under the registration number: RBR-658n6w.

Comparison of different electrotherapy methods and exercise therapy in shoulder impingement syndrome: A prospective randomized controlled trial

OBJECTIVE

The aim of this study was to assess and compare the effects of different electrotherapy methods and exercise therapy on pain, function and quality of life in shoulder impingement syndrome.

METHODS

Eighty-three patients (66 females, 17 males; mean age: 48.2 ± 7.33 years) with shoulder impingement syndrome were selected and 79 of them were randomly allocated into four groups. Group 1 (n = 19, mean age: 47.89 ± 7.12 years) was given hot pack and exercises, Group 2 (n = 20, mean age: 47.70 ± 6.51 years) was given hot packs, exercises and interferential current, Group 3 (n = 20, mean age: 48.50 ± 8.34 years) was given hot packs, exercises and TENS and Group 4 (n = 20, mean age: 48.55 ± 7.89 years) was given hot packs, exercises and ultrasound three times a week for four weeks. Assessments were made before treatment, right after it and three months after that using the visual analog scale (VAS), Short Form-36 (SF-36) and the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measures.

RESULTS

At the fourth week and third month assessments, all groups showed significant improvements in terms of pain, DASH and SF-36 physical component scores (p < 0.05). In intragroup comparisons, a significant difference between pre- and post-treatment results was found only in SF-36 mental component scores of Group 2. No significant difference was observed between the groups in any stage of the study period (p > 0.05).

CONCLUSION

Application of ultrasound, interferential current and TENS in addition to exercise therapy in shoulder impingement syndrome treatment had similar improvements in terms of pain, function and physical component of quality of life. However, interferential current treatment showed significantly better outcomes for the mental component of quality of life.

LEVEL OF EVIDENCE

Level I, Therapeutic study.

Are Passive Physical Modalities Effective for the Management of Common Soft Tissue Injuries of the Elbow?: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration

OBJECTIVE

To evaluate the effectiveness of passive physical modalities for the management of soft tissue injuries of the elbow.

METHODS

We systematically searched MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials from 1990 to 2015. Studies meeting our selection criteria were eligible for critical appraisal. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. We included studies with a low risk of bias in our best evidence synthesis.

RESULTS

We screened 6618 articles; 21 were eligible for critical appraisal and 9 (reporting on 8 randomized controlled trials) had a low risk of bias. All randomized controlled trials with a low risk of bias focused on lateral epicondylitis. We found that adding transcutaneous electrical nerve stimulation to primary care does not improve the outcome of patients with lateral epicondylitis. We found inconclusive evidence for the effectiveness of: (1) an elbow brace for managing lateral epicondylitis of variable duration; and (2) shockwave therapy or low-level laser therapy for persistent lateral epicondylitis.

DISCUSSION

Our review suggests that transcutaneous electrical nerve stimulation provides no added benefit to patients with lateral epicondylitis. The effectiveness of an elbow brace, shockwave therapy, or low-level laser therapy for the treatment of lateral epicondylitis is inconclusive. We found little evidence to inform the use of passive physical modalities for the management of elbow soft tissue injuries.

Fostering clinical reasoning in physiotherapy: comparing the effects of concept map study and concept map completion after example study in novice and advanced learners

BACKGROUND

Health profession learners can foster clinical reasoning by studying worked examples presenting fully worked out solutions to a clinical problem. It is possible to improve the learning effect of these worked examples by combining them with other learning activities based on concept maps. This study investigated which combinaison of activities, worked examples study with concept map completion or worked examples study with concept map study, fosters more meaningful learning of intervention knowledge in physiotherapy students. Moreover, this study compared the learning effects of these learning activity combinations between novice and advanced learners.

METHODS

Sixty-one second-year physiotherapy students participated in the study which included a pre-test phase, a 130-min guided-learning phase and a four-week self-study phase. During the guided and self-study learning sessions, participants had to study three written worked examples presenting the clinical reasoning for selecting electrotherapeutic currents to treat patients with motor deficits. After each example, participants engaged in either concept map completion or concept map study depending on which learning condition they were randomly allocated to. Students participated in an immediate post-test at the end of the guided-learning phase and a delayed post-test at the end of the self-study phase. Post-tests assessed the understanding of principles governing the domain of knowledge to be learned (conceptual knowledge) and the ability to solve new problems that have similar (i.e., near transfer) or different (i.e., far transfer) solution rationales as problems previously studied in the examples.

RESULTS

Learners engaged in concept map completion outperformed those engaged in concept map study on near transfer (p = .010) and far transfer (p < .001) performance. There was a significant interaction effect of learners' prior ability and learning condition on conceptual knowledge but not on near and far transfer performance.

CONCLUSIONS

Worked examples study combined with concept map completion led to greater transfer performance than worked examples study combined with concept map study for both novice and advanced learners. Concept map completion might give learners better insight into what they have and have not yet learned, allowing them to focus on those aspects during subsequent example study.

Availability, usage, and factors affecting usage of electrophysical agents by physical therapists: a regional cross-sectional survey

[Purpose] The aim of this study was to investigate the availability, usage, and factors affecting usage of electrophysical agents by physical therapists in Nagano Prefecture, Japan. [Subjects and Methods] Questionnaires were sent to all 1,571 physical therapists working in 245 institutions within Nagano Prefecture. A total of 1,110 questionnaires were returned, out of which 1,099 (70%) questionnaires containing valid responses were analyzed. Frequencies and percentages were calculated for 22 modalities with regards to availability, usage, rate of usage, and confidence level in usage. Factors affecting usage and the relationship between rate of usage and confidence level (Spearman’s rho) were also determined. [Results] The top three responses for the various outcome measures were as follows: (1) hot packs (88%), low frequency stimulators (76%), and ultrasound (68%) for availability; (2) hot packs (72%), ultrasound (61%), and cold packs (59%) for usage; (3) hot packs (75%), cold spray (49%), and ultrasound (44%) for confidence in usage; and (4) equipment availability (80%), past experience (79%), and research evidence (78%) for factors affecting usage. There was a significant positive relationship between confidence and usage for all modalities, except for ultraviolet radiation, iontophoresis, and magnetic field. [Conclusion] Usage was strongly correlated with confidence, with the top three used modalities also being the ones with the highest confidence in usage.

Is Interferential Current Before Pilates Exercises More Effective Than Placebo in Patients With Chronic Nonspecific Low Back Pain?: A Randomized Controlled Trial

OBJECTIVE

To determine whether interferential current (IFC) before Pilates exercises is more effective than placebo in patients with chronic nonspecific low back pain.

DESIGN

Two-arm randomized controlled trial, with a blinded assessor, and 6 months follow-up.

SETTING

Clinic of a school of physical therapy.

PARTICIPANTS

The random sample consisted of patients (N=148) of both sexes, with age between 18 and 80 years and chronic nonspecific low back pain. In addition, participants were recruited by disclosure of the treatment in the media.

INTERVENTIONS

Patients were allocated into 2 groups: active IFC + Pilates or placebo IFC + Pilates. In the first 2 weeks, patients were treated for 30 minutes with active or placebo IFC. In the following 4 weeks, 40 minutes of Pilates exercises were added after the application of the active or placebo IFC. A total of 18 sessions were offered during 6 weeks.

MAIN OUTCOME MEASURES

The primary outcome measures were pain intensity, pressure pain threshold, and disability measured at 6 weeks after randomization.

RESULTS

No significant differences were found between the groups for pain (0.1 points; 95% confidence interval, -0.9 to 1.0 points), pressure pain threshold (25.3kPa; 95% confidence interval, -4.4 to 55.0kPa), and disability (0.4 points; 95% confidence interval, -1.3 to 2.2). However, there was a significant difference between baseline and 6-week and 6-month follow-ups in the intragroup analysis for all outcomes (P<.05), except pressure pain threshold in the placebo IFC + Pilates group.

CONCLUSIONS

These findings suggest that active IFC before Pilates exercise is not more effective than placebo IFC with respect to the outcomes assessed in patients with chronic nonspecific low back pain.

Leadership and leadership development within the profession of physiotherapy in Ireland

BACKGROUND

Health service reform, physiotherapy graduate unemployment, and the impending introduction of state regulation mean that physiotherapists in Ireland today are facing many challenges. Leadership is needed to ensure that the profession will be able to adapt to the demands and inevitable changes ahead.

OBJECTIVE

To investigate the perceptions of physiotherapists in Ireland of leadership and leadership characteristics, and to explore their participation in leadership development training.

METHODS

In this cross-sectional nationwide study, an Internet-based survey was administered via e-mail to members of the Irish Society of Chartered Physiotherapists (n = 2,787).

RESULTS

There were 615 responses to the survey. A high proportion of respondents (74.0%) perceived themselves to be a leader. Factors associated with self-declaration as a leader were time since graduation, highest qualification attained, and leadership training. Leadership training was also associated with placing greater importance on achieving a leadership position. Some form of leadership training had been completed by 41.5% of respondents. Communication and professionalism were the most highly rated leadership characteristics in all three settings.

CONCLUSION

Physiotherapists who have had leadership training were more likely to perceive themselves to be leaders. Leadership training may support physiotherapists to assume leadership roles both clinically and nonclinically.

The Effectiveness of Physical Agents for Lower-Limb Soft Tissue Injuries: A Systematic Review

Study Design Systematic review. Background Soft tissue injuries to the lower limb bring a substantial health and economic burden to society. Physical agents are commonly used to treat these injuries. However, the effectiveness of many such physical agents is not clearly established in the literature. Objective To evaluate the effectiveness and safety of physical agents for soft tissue injuries of the lower limb. Methods We searched 5 databases from 1990 to 2015 for randomized controlled trials (RCTs), cohort studies, and case-control studies. Paired reviewers independently screened the retrieved literature and appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with a high risk of bias were excluded. We synthesized low-risk-of-bias studies according to principles of best-evidence synthesis. Results We screened 10261 articles. Of 43 RCTs identified, 20 had a high risk of bias and were excluded from the analysis, and 23 RCTs had a low risk of bias and were included in the analysis. The available higher-quality evidence suggests that patients with persistent plantar fasciitis may benefit from ultrasound or foot orthoses, while those with persistent midportion Achilles tendinopathy may benefit from shockwave therapy. However, the current evidence does not support the use of shockwave therapy for recent plantar fasciitis, low-Dye taping for persistent plantar fasciitis, low-level laser therapy for recent ankle sprains, or splints for persistent midportion Achilles tendinopathy. Finally, evidence on the effectiveness of the following interventions is not established in the current literature: (1) shockwave therapy for persistent plantar fasciitis, (2) cryotherapy or assistive devices for recent ankle sprains, (3) braces for persistent midportion Achilles tendinopathy, and (4) taping or electric muscle stimulation for patellofemoral pain syndrome. Conclusion Almost half the identified RCTs that evaluated the effectiveness of physical agents for the management of lower-limb soft tissue injuries had a high risk of bias. High-quality RCTs are still needed to assess the effectiveness of physical agents for managing the broad range of lower-limb soft tissue injuries. The effectiveness of most interventions remains unclear. Level of Evidence Therapy, 1a. Protocol registered July 10, 2014 with PROSPERO (CRD42014010621). J Orthop Sports Phys Ther 2016;46(7):523-554. Epub 6 Jun 2016. doi:10.2519/jospt.2016.6521.

Clinical decision making for using electro-physical agents by physiotherapists, an Israeli survey

Background

Electro-physical agents (EPAs) are fundamental components in the management arsenal of physiotherapy. The objective of this study was to provide a comprehensive understanding of the factors affecting the decisions made by Physiotherapists (PTs) when choosing to apply EPAs as a treatment modality.

Methods

A purpose-designed questionnaire was developed to investigate the contribution of 13 factors on the decision to use EPAs. Two hundred questionnaires were randomly distributed to PTs attending the annual conference of the Israeli Physiotherapy Society, 2014. The factors were grouped into six categories and Wilcoxon Sign Rank tests were applied to compare their impact on decision making.

Results

In total, 144 (72%) questionnaires were completed. Good internal consistency was found for the 13 component of the decisions factors (Cronbach’s coefficient alpha = 0.77) with unequal distribution of answers in each question (p < 0.01).

Eighty-one percent of the participants reported past experience, and 55 % mentioned research evidence as strong or very strong factors which influence their decision to use of EPAs. However, only 38% of the participants reported patients’ preferences as a strong or very strong factor. Comparisons between the six categories of the decision factors determined three levels of impact (rank scores) which were significantly different from each other (p < 0.01). Availability of equipment ranked the highest. The lowest level of impact included two categories, technology related issues and patients’ and physicians’ preferences.

Conclusion

The participating PTs were likely to make decisions which were strongly impacted by availability of equipment and operational factors. This research can be used to provide practicing PTs with a basis for a critical appraisal of their decision making regarding the application of EAPs. In addition, due to the strong impact of availability of equipment, health policy makers should verify that the available equipment is up to date with the best research evidence.

Example-based learning: comparing the effects of additionally providing three different integrative learning activities on physiotherapy intervention knowledge

BACKGROUND

Example-based learning using worked examples can foster clinical reasoning. Worked examples are instructional tools that learners can use to study the steps needed to solve a problem. Studying worked examples paired with completion examples promotes acquisition of problem-solving skills more than studying worked examples alone. Completion examples are worked examples in which some of the solution steps remain unsolved for learners to complete. Providing learners engaged in example-based learning with self-explanation prompts has been shown to foster increased meaningful learning compared to providing no self-explanation prompts. Concept mapping and concept map study are other instructional activities known to promote meaningful learning. This study compares the effects of self-explaining, completing a concept map and studying a concept map on conceptual knowledge and problem-solving skills among novice learners engaged in example-based learning.

METHODS

Ninety-one physiotherapy students were randomized into three conditions. They performed a pre-test and a post-test to evaluate their gains in conceptual knowledge and problem-solving skills (transfer performance) in intervention selection. They studied three pairs of worked/completion examples in a digital learning environment. Worked examples consisted of a written reasoning process for selecting an optimal physiotherapy intervention for a patient. The completion examples were partially worked out, with the last few problem-solving steps left blank for students to complete. The students then had to engage in additional self-explanation, concept map completion or model concept map study in order to synthesize and deepen their knowledge of the key concepts and problem-solving steps.

RESULTS

Pre-test performance did not differ among conditions. Post-test conceptual knowledge was higher (P < .001) in the concept map study condition (68.8 ± 21.8%) compared to the concept map completion (52.8 ± 17.0%) and self-explanation (52.2 ± 21.7%) conditions. Post-test problem-solving performance was higher (P < .05) in the self-explanation (63.2 ± 16.0%) condition compared to the concept map study (53.3 ± 16.4%) and concept map completion (51.0 ± 13.6%) conditions. Students in the self-explanation condition also invested less mental effort in the post-test.

CONCLUSIONS

Studying model concept maps led to greater conceptual knowledge, whereas self-explanation led to higher transfer performance. Self-explanation and concept map study can be combined with worked example and completion example strategies to foster intervention selection.

Effectiveness of passive physical modalities for shoulder pain: systematic review by the Ontario protocol for traffic injury management collaboration

BACKGROUND

Shoulder pain is a common musculoskeletal condition in the general population. Passive physical modalities are commonly used to treat shoulder pain. However, previous systematic reviews reported conflicting results.

PURPOSE

The aim of this study was to evaluate the effectiveness of passive physical modalities for the management of soft tissue injuries of the shoulder.

DATA SOURCES

MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials were searched from January 1, 1990, to April 18, 2013.

STUDY SELECTION

Randomized controlled trials (RCTs) and cohort and case-control studies were eligible. Random pairs of independent reviewers screened 1,470 of 1,760 retrieved articles after removing 290 duplicates. Twenty-two articles were eligible for critical appraisal. Eligible studies were critically appraised using the Scottish Intercollegiate Guidelines Network criteria. Of those, 11 studies had a low risk of bias.

DATA EXTRACTION

The lead author extracted data from low risk of bias studies and built evidence tables. A second reviewer independently checked the extracted data.

DATA SYNTHESIS

The findings of studies with a low risk of bias were synthesized according to principles of best evidence synthesis. Pretensioned tape, ultrasound, and interferential current were found to be noneffective for managing shoulder pain. However, diathermy and corticosteroid injections led to similar outcomes. Low-level laser therapy provided short-term pain reduction for subacromial impingement syndrome. Extracorporeal shock-wave therapy was not effective for subacromial impingement syndrome but provided benefits for persistent shoulder calcific tendinitis.

LIMITATIONS

Non-English studies were excluded.

CONCLUSIONS

Most passive physical modalities do not benefit patients with subacromial impingement syndrome. However, low-level laser therapy is more effective than placebo or ultrasound for subacromial impingement syndrome. Similarly, shock-wave therapy is more effective than sham therapy for persistent shoulder calcific tendinitis.

A survey of the attitudes and beliefs about the use of TENS for pain management by physiotherapists working in two cities in Sri Lanka

INTRODUCTION

Transcutaneous electrical nerve stimulation (TENS) is a noninvasive, inexpensive, self-administered technique used throughout the world to relieve pain. In Sri Lanka, physiotherapists may use TENS for their patients as they receive a small amount of education about the principles and practice of TENS in their undergraduate training. To date, there have been no data gathered about the use of TENS by physiotherapists in Sri Lanka. The aim of this study was to assess attitudes and beliefs of physiotherapists working in Sri Lanka about their use of TENS for pain management.

METHODS

A postal survey was undertaken using a 12-item questionnaire developed by the investigators to gather information about attitudes, beliefs and use of TENS in clinical practice. The questionnaire was distributed to 100 physiotherapists working in three government hospitals and six private hospitals in the cities of Kandy and Colombo. A descriptive analysis of data was performed.

RESULTS

Sixty-seven completed questionnaires were returned (67% response rate). Over half of the respondents (58.2%) reported that they used TENS to treat pain "often" or "very often", with use for musculoskeletal/orthopedic (61.3%) and neuropathic/neuralgic (79.1%) pain being most common. TENS was used less for postsurgical pain and rarely for cancer pain. Most (95.5%) respondents reported that their patients benefitted "considerably" from TENS. 76.1% of the respondents reported that they did not recommend and/or prescribe TENS for patients to use at home.

CONCLUSION

Physiotherapists value TENS as a treatment option to manage musculoskeletal and neuropathic pain. However, there is a need for systems and resources to enable to patients to self-administer TENS rather than having to visit clinics.

Usage Patterns and Beliefs about Therapeutic Ultrasound by Canadian Physical Therapists: An Exploratory Population-Based Cross-Sectional Survey

PURPOSE

To explore the frequency and patterns of ultrasound (US) usage among physical therapists, to describe the most common purposes for using therapeutic US, and to investigate beliefs about therapeutic US.

METHODS

A survey was sent to 95% of physical therapists licensed to practise in the province of Alberta, Canada.

RESULTS

Of 2,269 physical therapists to whom email invitations were sent, 438 (19.3%) provided full responses. RESULTS indicate that US is still frequently incorporated into treatment regimens and is widely believed to be effective; however, the study also found a decrease in US usage over the past 15 years. While physical therapists recognize the lack of evidence for the effectiveness of US, many consider it clinically useful. Physical therapists using US rely largely on their clinical experience when making decisions about its use, but this depends on level of education: clinicians with an MScPT degree tended to base more of their US decisions on research evidence, likely because of the increasing emphasis on research evidence in graduate education.

CONCLUSIONS

Despite the questionable effectiveness of therapeutic US, physical therapists still commonly use this treatment modality, largely because of a belief that US is clinically useful. However, US usage has decreased over the past 15 years.

Assessment of physiotherapists' occupational exposure to radiofrequency electromagnetic fields from shortwave and microwave diathermy devices: a literature review

We reviewed studies reporting the strength of radiofrequency (RF) electromagnetic fields (EMF) in physiotherapists' occupational environment. Studies from academic journals published from January 1990 to June 2010 were identified in nine online bibliographic databases. EMF strength was compared with occupational exposure limits (OELs) recommended by the International Commission on Non-Ionizing Radiation Protection (ICNIRP). In the reviewed studies, EMFs were measured at different distances (range 0.2 m to 6 m) from the console of diathermy devices, electrodes, and cables. For continuous shortwave diathermy (CSWD) (27.12 megahertz, MHz), measurements of EMFs at < 1 m, 1 m, 1.1-1.5 m, and 2 m reported the maximum E field strength as 8197%, 1639%, 295%, and 69%, respectively, and the maximum H field strength as 6250%, 681%, 213%, and 56%, respectively, of the ICNIRP limits for E and H fields for occupational exposure. For pulsed shortwave diathermy (PSWD) (27.12 MHz), EMF measurements at < 1 m, 1 m, and, 1.1-1.5 m showed the maximum E field intensity as 1639%, 175%, and 32%, and the maximum H field strength as 1175%, 968%, and 28%, respectively, of the ICNIRP limits for E and H fields for occupational exposure. For microwave diathermy (MWD) (2.45 gigahertz, GHz), the maximum power density measured at < 1 m, 1 m, 1.1-1.5 m, and 2 m was 200%, <30%, 0.76%, and 0.82%, respectively, of the ICNIRP limit for occupational exposure. RF EMF emissions measured from continuous and pulsed electrotherapeutic diathermy devices may well be higher than OELs at specific distances, i.e., at 1 m, which is currently designated to be a safe distance for physiotherapists. The minimum safe distance for physiotherapists should be revised to at least 2 m for CSWD and 1.5 m for PSWD. The reviewed studies did not provide evidence of exceeding the ICNIRP's reference levels for occupational exposure at 1 m from MWD devices.

Influence of the timing of ultrasound application on the penetration of corticosteroids

BACKGROUND

The application of ultrasound to enhance the transdermal transport of drugs is often referred to as 'sonophoresis'. In physiotherapy sonophoresis is applied to the skin through two different procedures: (1) the pre-treatment procedure where the skin is treated with ultrasound irradiation prior to the drug application and (2) a simultaneous treatment mode, where the skin is treated with ultrasound during the application of the pharmacologic substance. The aim of this study was to compare the bioavailability of halcinonide in the stratum corneum comparing the ultrasound pre-treatment vs. the simultaneous treatment method.

METHODS

The effect of pre and simultaneous ultrasound treatment (1 MHz, 1 W/cm(2)) was evaluated on the halcinonide blanching response using tristimulus colorimetry 2 h after the initial application.

RESULTS

Within the evaluation period, only the ultrasound pre-treatment method resulted in a significant blanching response.

CONCLUSION

Timing of the ultrasound application seems to influence the availability and percutaneous penetration process and should be taken into account when estimating the ultrasound enhancing effect.

Transcutaneous electrical nerve stimulation for the management of painful conditions: focus on neuropathic pain

The management of neuropathic pain is challenging, with medication being the first-line treatment. Transcutaneous electrical nerve stimulation (TENS) is an inexpensive, noninvasive, self-administered technique that is used as an adjunct to medication. Clinical experience suggests that TENS is beneficial providing it is administered at a sufficiently strong intensity, close to the site of pain. At present, there are too few randomized controlled trials on TENS for neuropathic pain to judge effectiveness. The findings of systematic reviews of TENS for other pain syndromes are inconclusive because trials have a low fidelity associated with inadequate TENS technique and infrequent treatments of insufficient duration. The use of electrode arrays to spatially target stimulation more precisely may improve the efficacy of TENS in the future.