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PubMed1997

A multidimensional scaling analysis of the techniques that physiotherapists use.

Following the essentially 'hands-on' origin of the physiotherapy profession a century ago, the range of techniques available to practitioners has expanded considerably. While this expansion of techniques has been of research interest, the main focus has been upon individual techniques, thus neglecting the fundamental question of the use of techniques in combination. In addition, researchers have tended to treat the profession as homogeneous, thus overlooking possible differences in technique usage. The present study addressed these questions. It postulated that ordered combinations of techniques usage would be employed, and that a typology would exist that differentiates the profession according to patterns of use. The study comprised a questionnaire survey of 230 clinical physiotherapists in England. This sought information on the range and frequency of techniques used over the previous six months. Descriptive analysis indicated a high frequency of use of several techniques, notably exercise therapy, passive mobilisation techniques and ultrasound. A feature of the analysis was the use of two multivariate procedures, multidimensional scalogram analysis (MSA) and smallest space analysis (SSA). The SSAs revealed a clear structure concerning combinations of techniques used, and the MSAs provided a coherent typology based upon this usage. One feature of the techniques in combination that emerged was the frequent use of passive mobilising techniques, which was associated with equally frequent use of electrotherapy techniques. In contrast, respondents who employed neurological or respiratory techniques made little use of electrotherapy. Regarding the typology, differentiation of the profession according to use of particular combinations of techniques indicated probable specialisms. The specialist areas identified were neurological physiotherapy, respiratory physiotherapy and musculo-skeletal physiotherapy. The results reinforce the need for both future research and physiotherapy education to address the issue of techniques in combination. Finally, and on the basis of the analyses, elements of a theoretical model are advanced that may provide directions for future research.

England↗

PubMed2003

[Analgesic physical therapy. Present clinical data].

Analgesic electrotherapy is now based on more consistent scientific data; the biological action of the electric current, of the electromagnetic radiations and of the mechanical vibrations is better approached. But the randomized control trials still provide contradictory results concerning the analgesic efficiency of the cryotherapy, the TENS, the pulsed electro-magnetic fields, the ultrasound and laser therapy, the shock waves; iontophoresis, short waves, microwaves, infrasound vibrations are very few investigated. The analgesic electrotherapy cannot be recommended nor prohibited; physical agents represent only therapeutic options. On the basis of the scientific data and of their personal experience, the therapists can use them. More controlled clinical investigations of higher methodological levels are still required.

Analgesia↗

PubMed1999

Physical and other non-pharmacological interventions for fibromyalgia.

There is little empirical evidence for the effectiveness of physical and other non-pharmacological approaches to the management of fibromyalgia. Although a number of studies have been conducted into such approaches, many of these are uncontrolled, and relatively few randomized controlled trials of appropriate size and methodological rigour have been carried out. This chapter provides an overview of the evidence available under the following headings: exercise, EMG biofeedback training, electrotherapy and acupuncture, patient education and self-management programmes, multimodal treatment approaches, and other interventions. It is hard to reach firm conclusions from the literature, owing to the variety of interventions that have been evaluated and the varying methodological quality of the studies concerned. Nonetheless, in terms of specific interventions, exercise therapy has received a moderate degree of support from the literature, and has been subjected to more randomized studies than any other intervention. In contrast, there is little or no evidence available for most types of electrotherapy. In terms of overall management strategies, a multimodal programme of management, including physical, psychological and educational components and delivered in a multidisciplinary setting, has gained some support from descriptive and experimental studies, and accords with current understanding of the aetiology and clinical features of fibromyalgia. There is a clear need for further systematic evaluation of the effectiveness of non-pharmacological treatment approaches in fibromyalgia.

Acupuncture Therapy↗

PubMedDate not supplied

[Etiology of hip dislocation in children with cerebral movement disorders and possibilities of conservative treatment using rotating and spreading plates and electrostimulation].

Dislocations of the hip associated with spastic paralysis are almost always found in severely disabled children. The onset is in infancy. Two methods, electrostimulation of the minor gluteal muscles and treatment with simple leg casts to correct the malposition, are described. Follow-up examinations showed that the treatment had had a positive effect on the hip condition in 33 of the 42 children treated with casts and 26 of the 32 children treated by electrotherapy. Electrotherapy is an innovation, since in the past it was considered contraindicated in these patients. However, it is based on the fact that the gluteal muscles do not normally show any spasticity. Irrespective of this, the treatment is long-term, and has to be continued for many years, a fact which makes greater demands on the cooperativeness of the family.

Adolescent↗

PubMed2003

Effectiveness of physiotherapy for lateral epicondylitis: a systematic review.

AIM: To evaluate the available evidence of the effectiveness of physiotherapy for lateral epicondylitis of the elbow. METHOD: Randomised controlled trials (RCTs) identified by a highly sensitive search strategy in six databases in combination with reference checking. Two independent reviewers selected RCTs that included a physiotherapy intervention, patients with lateral epicondylitis, and at least one clinically relevant outcome measure. No language restrictions were made. Methodological quality was independently assessed by two blinded reviewers. A best evidence synthesis, including a quantitative and qualitative analysis, was conducted, weighting the studies with respect to their internal validity, statistical significance, clinical relevance, and statistical power. RESULTS: 23 RCTs were included in the review, evaluating the effects of lasertherapy, ultrasound treatment, electrotherapy, and exercises and mobilisation techniques. Fourteen studies satisfied at least 50% of the internal validity criteria. Except for ultrasound, pooling of data from RCTs was not possible because of insufficient data, or clinical or statistical heterogeneity. The pooled estimate of the treatment effects of two studies on ultrasound compared to placebo ultrasound, showed statistically significant and clinically relevant differences in favour of ultrasound. There is insufficient evidence either to demonstrate benefit or lack of effect of lasertherapy, electrotherapy, exercises and mobilisation techniques for lateral epicondylitis. CONCLUSIONS: Despite the large number of studies, there is still insufficient evidence for most physiotherapy interventions for lateral epicondylitis due to contradicting results, insufficient power, and the low number of studies per intervention. Only for ultrasound, weak evidence for efficacy was found. More better designed, conducted and reported RCTs are needed.

Australia↗

PubMed2002

Management of back pain.

PURPOSE: Low back pain (LBP) constitutes one of the most difficult and costly medical problems in industrial countries, with a prevalence of 25 to 30% in an adult lifetime span and an incidence of about 5% per year. METHOD: Based on risk factors cited in the pertinent literature, the evaluation, diagnosis and therapeutic options for LBP are outlined. Especially the latter can be highlighted on the basis of a large number of systematic reviews. RESULTS: Bed rest is no longer regarded as an effective treatment for episodes of acute LBP, except when the patient has evident clinical signs of nerve root compression. Exercise therapy comprises a wide range of concepts and underlying physiological principles. Different concepts are discussed. Evidence suggests no specific effects of exercise therapy in acute LBP. In chronic LBP, exercise as well as combined treatment with several modalities appear to be superior to conventional medical care. In the past decade, reconditioning of the paraspinal muscles is being given increasing importance in research. Several studies indicate the effectiveness of vigorous strengthening of paraspinal and trunk muscles on pain and even disc surgery. Different underlying pathologies seem to respond equally well to this concept. Back school concepts are not proven to have long-term effects on LBP. The literature on electrotherapy and massage in LBP is generally sparse. Nevertheless, some studies suggest the effectiveness of electrotherapy on pain reduction at least in the short term. Spinal mobilization seems to be effective in reducing pain. CONCLUSION: Based on these evidence-based conclusions, the patient's medical history, the investigation and the diagnosis the clinician has to devise an individual treatment plan that takes the deficiencies and requirements of the patient into account.

Evidence-Based Medicine↗

PubMed1977

Treatment of the neurogenic bladder with direct current on the spinal cord (Myelotron).

We carried out urodynamic examinations before and after galvanotherapy (Myelotron) of the spinal cord in 25 patients with upper and lower motor neuron lesions, mixed lesions and sensory lesions of the bladder. With the upper motor neuron lesions (neurogenic unhibited bladder, dyssynergia) there was a deterioration of the condition and therefore electrotherapy is contraindicated in this group of patients. With the lower motor neuron lesions and also the sensory lesions definite success was achieved with electrotherapy. Where there is a deficiency of impulses, it would appear to be compensated.

Adult↗

PubMed2004

Antitumor effectiveness of different amounts of electrical charge in Ehrlich and fibrosarcoma Sa-37 tumors.

BACKGROUND: In vivo studies were conducted to quantify the effectiveness of low-level direct electric current for different amounts of electrical charge and the survival rate in fibrosarcoma Sa-37 and Ehrlich tumors, also the effect of direct electric in Ehrlich tumor was evaluate through the measurements of tumor volume and the peritumoral and tumoral findings. METHODS: BALB/c male mice, 7-8 week old and 20-22 g weight were used. Ehrlich and fibrosarcoma Sa-37 cell lines, growing in BALB/c mice. Solid and subcutaneous Ehrlich and fibrosarcoma Sa-37 tumors, located dorsolaterally in animals, were initiated by the inoculation of 5 x 10(6) and 1 x 10(5) viable tumor cells, respectively. For each type of tumor four groups (one control group and three treated groups) consisting of 10 mice randomly divided were formed. When the tumors reached approximately 0.5 cm3, four platinum electrodes were inserted into their bases. The electric charge delivered to the tumors was varied in the range of 5.5 to 110 C/cm3 for a constant time of 45 minutes. An additional experiment was performed in BALB/c male mice bearing Ehrlich tumor to examine from a histolological point of view the effects of direct electric current. A control group and a treated group with 77 C/cm3 (27.0 C in 0.35 cm3) and 10 mA for 45 min were formed. In this experiment when the tumor volumes reached 0.35 cm3, two anodes and two cathodes were inserted into the base perpendicular to the tumor long axis. RESULTS: Significant tumor growth delay and survival rate were achieved after electrotherapy and both were dependent on direct electric current intensity, being more marked in fibrosarcoma Sa-37 tumor. Complete regressions for fibrosarcoma Sa-37 and Ehrlich tumors were observed for electrical charges of 80 and 92 C/cm3, respectively. Histopathological and peritumoral findings in Ehrlich tumor revealed in the treated group marked tumor necrosis, vascular congestion, peritumoral neutrophil infiltration, an acute inflammatory response, and a moderate peritumoral monocyte infiltration. The morphologic pattern of necrotic cell mass after direct electric current treatment is the coagulative necrosis. These findings were not observed in any of the untreated tumors. CONCLUSION: The data presented indicate that electrotherapy with low-level DEC is feasible and effective in the treatment of the Ehrlich and fibrosarcoma Sa-37 tumors. Our results demonstrate that the sensitivity of these tumors to direct electric current and survival rates of the mice depended on both the amount of electrical charge and the type of tumor. Also the complete regression of each type of tumor is obtained for a threshold amount of electrical charge.

Animals↗

PubMed2005

[Electrochemotherapy and its mechanism for sarcoma of KM mice].

In this paper are analyzed the effect of electrochemotherapy and its mechanism. The favorable parameter of electric pulses (EP) was studied in vitro using the S-180 cells exposed to various EP. After the tumor model was copied, the tumor-bearing mice were randomly divided into four groups: control, chemotherapy, electrotherapy, and electrochemotherapy. The tumor inhibitory ratio, the cure ratio and the level of oxygen free radicals (OFR) were determined. The inhibitory ratio and cure ratio of electrochemotherapy group were significantly higher than those in the chemotherapy, electrotherapy and control groups (P < 0.05). The injury of OFR was decreased while the immunological competence was increased. The mechanism of electrochemotherapy may be related with the enhancement of cell membranepermeability, the depression of drug resistance, the improvement of immunological competence, and so on.

Animals↗

PubMed1978

[Transcutaneous electroanalgesia and naloxone. Clinical aspects (author's transl)].

Recently, Mayer (1977) and Adams (1976) proved that both acupuncture and direct electrostimulation of deep encephalic structures produce an analgesic effect releasing a neurotransmitter similar to morphine (endorphine). We have verified this hypothesis, using the transcutaneous electrotherapy in five patients with chronic pain at the back (postherpetic neuralgia in 3, pain cancer in 2). All patients related a certain analgesic effect during electrotherapy, with a reduction in pain of more than 50 per cent. During electroanalgesia we administered Naloxone (an antagonist of morphine). In 3 cases we observed a clear, although short, return of algic symptomatology. At the contrary, in other two patients Naloxone caused briefly a further and clear reduction in the pain.

Adult↗

PubMed1988

Clinical application of electrotherapeutic modalities.

The purposes of this survey study were 1) to determine the frequency of use of eight forms of electrical stimulation and ultrasound in clinical practice and 2) to determine the factors that influence how and when these forms of electrical stimulation are used. A survey questionnaire was distributed to 490 physical therapists in clinics affiliated with the academic programs of Ithaca College and Temple University. Forty-five percent (221) of the distributed surveys were returned. Descriptive statistics and chi-square calculations were used in the data analysis. Respondents frequently used two forms of pulsed current and rarely used two forms of alternating current. No form of electrical current was used as frequently as ultrasound. The frequency and type of electrical stimulation used depended on the availability of electrical stimulators and the adequacy of entry-level training in electrotherapy. The results of this study suggest the need for additional electrical stimulators in physical therapy clinics, training for physical therapists, and research in electrotherapy.

Electric Stimulation↗

PubMed1986

[Physical therapy of arthroses].

The physical therapy of arthrosis as a symptomatic and stage-oriented therapy is illustrated in a review. All of the various therapeutic procedures are discussed regarding their effectiveness and applicability in the different stages. There have been some changes within the last few decades and treatments have been introduced with more or less success. Mild thermotherapy of active arthrosis, suggested earlier, has been replaced by cryotherapy, which is more effective. Peloid therapy has now also been introduced into this cryotherapy, which only used to be applied as a type of heat therapy. Naturally, most of the new developments are in the field of electrotherapy. Nevertheless, the newer types have not led to any significant improvement in therapeutic success compared with "classical" electrotherapy (diadynamic, Träbert ultrastimulation, interferential current). The only remarkable innovation seems to be therapy with low-frequency magnetic fields, although the basic means of the working mechanism have not been thoroughly investigated. Regarding the most recent publications, laser therapy has not shown complete proof of its effectiveness. Passive physical therapy of arthrosis only shows persistent success when it is combined with a careful amount of physical therapy.

Bone Diseases↗

PubMed1994

Electric treatment of human melanoma skin lesions with low level direct electric current: an assessment of clinical experience following a preliminary study in five patients.

In this study we have investigated the effects of negative low level direct electric current electrotherapy (current: 1 milliampere; treatment time: 30 minutes) in metastatic or primary melanoma skin lesions. After 12 applications in five patients, tumour regression was observed in all evaluable melanoma skin lesions; four of them were classified as partial responses. This study shows that locally applied electrotherapy with a negative low level direct electric current is an effective treatment that results in reduction of tumour mass of human melanoma skin lesions, and it is possible that it has a positive influence on the course of the metastatically disseminated melanoma. No serious side effects were observed.

Adult↗

PubMedDate not supplied

[The use of combined methods of magnetoelectrotherapy in treating polyneuropathies].

A comparative evaluation by such parameters as alleviation of pain syndrome, improvement of peripheral resistance and vegetotrophic processes, a decline in pareses and sensory disorders has been performed in 3 groups of patients: group 1 underwent benzohexonium electrophoresis, group 2 benzohexonium electrophoresis in the magnetic field produced by the unit "Polyus-I" followed by low-frequency electrotherapy with bipolar impulse current, group 3 benzohexonium electrophoresis in the magnetic field from the unit "ADMT-Magnipuls" followed by low-frequency electrotherapy with bipolar impulse current. The best clinical and physiological results were reported in group 3 patients.

Adolescent↗

PubMedDate not supplied

[Changes in pacemakers and the wearers of pacemakers as a result of the use of different electromagnetic energy sources].

Over the past decade there have been considerable advances in cardiac electrostimulation technologies. However, there are still reports of electromagnetic interference with pacemakers and pacemaker patients. We have studied the effects of various electromagnetic sources (short-wave diathermy, electrosurgical knives, electrotherapy and radiofrequencies) on both humans and animals. The results of the studies were completely negative and, therefore, we are convinced that today's pacemakers are much more reliable and hence less subject to interference from external electromagnetic sources. We performed the following tests: (a) Short-wave diathermy: various electrode positions in pigs and 8 patients with pacemakers. (b) Electrosurgical knives: several tests on pigs with unipolar electrosurgical knife; 6 tests on humans during automatic defibrillator implantation using two-pole electrosurgical knives; 23 pacemaker patients underwent abdominal surgery (3 inguinal hernias, 12 gastric resections; 6 cholecystotomies, 2 aortic aneurysms-with two-pole electrosurgical knives). (c) Electrotherapy (TENS): on pigs. (d) Radiofrequency (RF) for transcatheter ablation-several tests on pigs.

Animals↗

PubMed1994

The quantitative measurement of spasticity: effect of cutaneous electrical stimulation.

The goal of this research was to determine if cutaneous electrotherapy would temporarily reduce muscle spasticity. Five traumatically brain injured (TBI) and five spinal cord injured (SCI) subjects, all with clinically evident spasticity, received surface electrical stimulation over the tibialis anterior muscle. Using the Spasticity Measurement System, stiffness around the ankle was measured before, immediately after, and 24 hours after treatment. With stimulation, ipsilateral ankle viscoelastic stiffness immediately decreased in 9 of 10 subjects and remained significantly depressed for up to 24 hours. Contralateral ankle spasticity did not significantly change. Using the same subjects under sham conditions, no significant decrements in spasticity occurred. In a subjective survey, only SCI participants reported functionally evident spasticity reductions. Also within this subgroup, efficacy of treatment was directly proportional to the severity of pre-stimulation clonus. We conclude that (1) cutaneous electrotherapy transiently decreases both TBI and SCI related spasticity and (2) pre-stimulation clonus may function as a clinical indicator of SCI patients most likely to benefit from this process.

Adult↗

PubMed1998

[Incontinence--a problem in women and men].

Different pathophysiology causes different types of incontinence. Urge-, Stress-, Overflow-, Reflex- and Extrasphincteric incontinence therefore need different therapeutic strategies. The basic diagnostic work-up, which can be done by any doctor in free practice comprises history, clinical investigation, urine analysis, the micturition protocol (frequency-volume-chart = FVC) and post voiding residual urine (PVR). In 80% of the elderly incontinent persons incontinence can be evaluated by basic diagnostics to such an extent, that conservative therapy can be started. If after basic diagnostic work-up the type of incontinence remains unclear, if it is a postoperative recurrent urinary incontinence, if reflex incontinence is present, or if conservative therapy is not successful within 3 weeks a further diagnostic workup by the specialist is mandatory. The specialist will perform echography of the urinary tract, endoscopy and especially urodynamics to evaluate detrusor and sphincter dysfunction precisely, if necessary also combined with X-ray (video-urodynamics). In regards to urinary stress incontinence conservative treatment strategies e.g. pelvic floor training programs, if necessary combined with electrotherapy and biofeedback have gained increasing importance. For urge-incontinence continence training programs and pharmacotherapy as well as electrotherapy are the main therapies. Reflex-incontinence should be treated by the specialist. Overflow incontinence is easy to diagnose, however, the treatment of the underlying pathophysiology must be done by the urologist. Urinary incontinence in the elderly is a special problem. Treatment of incontinence with incontinence aids (pads) only is justified in immobile and demented people, in others active treatment, comprising continence training programs and pharmacotherapy should be the goal. A Foley catheter is only justified if urinary incontinence is combined with an insufficient bladder emptying with residual urine, which can not be treated otherwise.

Diagnosis, Differential↗

PubMed1998

[Therapeutic strategies in acute myocardial infarction: antiarrhythmic therapy].

Antiarrhythmic therapy is a special case in the therapeutic strategy of acute myocardial infarction. There are very few controlled therapeutic trials and its use is mainly based on clinical experience rather than on scientific evidence. The most common arrhythmias requiring treatment in acute myocardial infarction are atrial fibrillation, ventricular tachycardia and ventricular fibrillation. There is no evidence to support the use Class I antiarrhythmics. Lidocain may be used in some cases. Similarly, contradictory results have been reported with the use of magnesium salts and the general tendency is not to use this ion in acute myocardial infarction. The most commonly used antiarrhythmic agents are the betablockers and amiodarone. The general principles of treatment should be respected: all antiarrhythmic drugs have negative inotropic effects, apart from digitalis. All antiarrhythmics may have a proarrhythmic effect including digitalis, especially in this clinical context. Whenever possible, continuous intravenous infusions are to be preferred to bolus injections. In addition, and when possible, electrotherapy is preferable to antiarrhythmic drug therapy. Finally, a number of cardiac arrhythmias observed in acute myocardial infarction should be "respected" or treated by electrotherapy but never by antiarrhythmic drugs.

Adrenergic beta-Antagonists↗