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PubMedDate not supplied

Physical therapy modalities for wound management.

As part of a multidisciplinary team approach to the management of chronic wounds, physical therapists can add certain physical modalities to the care plan. Whirlpool, electrical stimulation, ultrasound, low-energy laser and compression therapy are physical therapy modalities that have been used to enhance wound healing. All of these modalities are used as adjunct treatments that, when appropriate, may help shorten the length of treatment and reduce patient suffering. Because the efficacy of some of these modalities remains to be established in controlled clinical trials, conventional wound care continues to be an important part of the team approach.

Chronic Disease↗
PubMed2006

Physical therapy modalities in management of fibromyalgia.

The etiology of fibromyalgia syndrome (FM) is uncertain and the prognosis for symptomatic recovery is generally poor. A wide variety of interventions are used in the management of FM. There is, however, no clear consensus on the treatment of choice and FM remains relatively refractory to treatment. Therefore, prevention, causal therapy and rehabilitation are not possible. FM patients frequently use alternative therapies, indicating dissatisfaction or ineffectiveness of traditional medical therapy. Alternative therapies are generally perceived to be more "natural" and as a result, to have fewer adverse effects. Despite the positive results found, the number of publications related to the application of physical therapy modalities such as acupuncture, transcutaneous electrical stimulation, laser, biofeedback, electrotherapy and magnetic field is still scant, especially concerning FM treatment. The demonstration of a long-term effective intervention for managing the symptoms associated with FM is needed. Multidisciplinary approaches to management include physical and medical therapeutic strategies. Treatment modalities should be individualised for patients based on target symptoms and impairment in functioning. Patience and positive attitude on part of the physician and active involvement of patients and their families in treatment are likely to enhance improvement. It can be concluded that there is a need for larger, more systematic and methodologically sound randomised controlled clinical trials to evaluate the effectiveness of physical therapy modalities of managing FM. We will review some of the existing studies of physical therapy relevant in the treatment of FM and give some practical advice for their use.

Acupuncture↗
PubMed1997

An assessment of the efficacy of physical therapy and physical modalities for the control of chronic musculoskeletal pain.

An analysis of review articles and controlled clinical trials for temporomandibular disorders and similar chronic musculoskeletal pain disorders was carried out. Although little evidence was found that any specific therapy had long-term efficacy greater than placebo, we did find strong evidence that symptoms improve during treatment with most forms of physical therapy, including placebo. When the frequency of significant between-group differences in trials that used placebo and waiting list control (i.e., no treatment) groups were compared, it was found that treatment was better than placebo in only 7/22 trials, whereas treatment was almost always better than no treatment (15/16). This difference was highly significant (P = 0.001). A similar analysis of trials that included more than one treatment group showed that while equal amounts of treatment were usually associated with equal outcome (9/10), unequal treatment regimes led to unequal outcome (10/15; P = 0.012). The group that received the most therapy appeared to do best. In conclusion, it seems that patients are helped during the period that they are being treated with most forms of physical therapy. However, most of these therapies have not been shown to be more efficacious than placebo.

Animals↗
PubMed1999

The role of physical therapy and physical modalities in pain management.

This article provides an overview to arthritis care of the common physical modalities (heat, cold, transcutaneous electrical nerve stimulation, low-energy laser, topical applications, and external devices). The rationale for use and effectiveness of the various physical modalities are discussed. Exercise is presented in terms of mode and effect of range of motion, muscle conditioning, and aerobic exercise.

Arthritis↗
PubMed1991

Physical modalities of therapy in pediatric rheumatic diseases.

The approach to rehabilitation management of childhood rheumatic disease differs in many ways from that of adult disease. Among the special considerations are the effects of chronic musculoskeletal inflammation in a growing and developing individual and the tendency of children to tighten their joints into positions of comfort, with fewer problems resulting from ligamentous laxity and instability. A comprehensive management approach includes much more than simply using medications--the tendency for the disease to exert deforming forces on the limbs must be constantly fought by a vigorous program of rehabilitation; education and psychologic support must be provided to the patient and family; potential problems must be discussed with the school; financial and vocational issues must be addressed.

Activities of Daily Living↗
PubMed1984

Some guidelines for the use of physical modalities.

Physical therapy should be thought of in the same manner as any form of therapy, with its indications, contraindications, and side effects. The clinician should set up priorities in this form of treatment, which will be dictated by the disease or condition to be treated or by the complaints of the patient. Pain is usually a top priority, followed by swelling and biomechanical problems, including contractures.

Arthritis↗
PubMed1995

Chest physical therapy management of patients with cystic fibrosis. A meta-analysis.

The purpose of this overview is to quantitatively assess the conflicting body of literature concerning the efficacy of physical therapy modalities for clearing bronchial secretions in the treatment of patients with cystic fibrosis (CF). The modalities examined included positive expiratory pressure (PEP) mask, forced expiratory technique (FET), exercise (EX), autogenic drainage (AD), and standard physical therapy (STD), consisting of postural drainage, percussion, and vibration. Computerized searches of the MEDLINE and Cumulative Index for Nursing and Allied Health databases were performed for the years from 1966 to 1993. The authors of relevant papers were contacted for unpublished information. Studies were considered relevant if they met the following criteria: randomized trials in patients with a definite diagnosis of CF; an intervention of any combination of PEP, FET, STD, AD, or EX; and an outcome of FEV1, sputum weight, or sputum clearance. A review of 456 citations yielded 65 potentially relevant trials and 8 review articles; of these, 35 met the inclusion criteria and were incorporated into the overview. These studies evaluated different combinations of physical therapy modalities; therefore, we performed seven separate meta-analyses comparing the independent techniques using the pooled effect size technique. Standard physical therapy resulted in a significantly greater sputum expectoration than no treatment (effect size of 0.61 SD units, p < 0.0001). The combination of standard therapy with EX with associated with a statistically significant increase in FEV1 over STD alone (effect size of 0.48 SD units, p = 0.04). No other differences between physical therapy modalities were found.

Cystic Fibrosis↗
PubMed2005

Current use of lumbar traction in the management of low back pain: results of a survey of physiotherapists in the United Kingdom.

OBJECTIVE: To identify the current use of traction and the types of patients, treatment parameters, and treatment modalities used in conjunction with traction. DESIGN: Postal survey, with 4 sections: professional characteristics of respondent, current use of traction, patient selection, and treatment parameters. SETTING: Musculoskeletal outpatient departments (private and nonprivate practitioners). PARTICIPANTS: Random sample (N=1491) of chartered physiotherapists in the UK who work in the management of low back pain (LBP). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Descriptive analysis of information on current use and practice in applying traction. RESULTS: A response rate of 83% (n=1239) was achieved; 41% (n=507) use lumbar traction, which is most commonly used in the management of subacute LBP patients presenting with nerve root symptoms. Treatment parameters were established for weights (5-60 kg), frequency (2-3 times weekly), and length of treatment (4 wk). In addition, traction is commonly used with other modalities (87%): mobilizations, advice, and exercise. CONCLUSIONS: Survey results show the continued use of lumbar traction despite the recommendations of numerous guidelines. Results also clarify the types of patients and the parameters used in the application of traction.

Attitude of Health Personnel↗
PubMed2005

Physiotherapy management of low back pain in Thailand: a study of practice.

BACKGROUND AND PURPOSE: Low back pain (LBP) is one of the most common musculoskeletal disorders in both developed and developing countries. Whilst there have been a number of studies investigating the current physiotherapy management of LBP in the former, little is known about such management in developing countries. The objectives of the present study were to investigate the physiotherapy management of LBP in Thailand and to compare the results with those of developed countries where applicable. METHOD: A cross-sectional survey was undertaken to collect information on physiotherapists, LBP patients and treatment interventions used, using a Thai version of an available (English) questionnaire. Subsequent to a pilot study with 32 Thai therapists, minor revisions were made and the final questionnaires were mailed to all 776 physiotherapists currently working throughout Thailand. RESULTS: Responses were received from 559 therapists (a 77.2% response rate), and 502 of these were currently involved in LBP management. Results indicated that LBP patients made up, on average, 37.5% of their patient caseloads. Electrophysical modalities, especially hot packs (64%), ultrasound (61%) and mechanical traction (61%), were reported to be the most commonly used treatments, particularly by hospital-based therapists, whereas those working in university-based hospitals and private clinics were more likely to use manual therapy. CONCLUSIONS: This study provides descriptive data from the therapists' perspective about LBP management and shows that the treatments most commonly used are different from those treatments commonly used in developed countries. The potential reasons for this are explored in this paper and recommendations are made for further research.

Adult↗
PubMed2006

Evidence based practice: a survey of physiotherapists' current practice.

BACKGROUND AND PURPOSE: [corrected] Evidence-based practice is the explicit use of current best evidence in making decisions about the care of individual patients and is a concept of growing importance for physiotherapy. The aim of the present study was to investigate Australian physiotherapists' self-reported practice, skills and knowledge of evidence-based practice and to examine differences between recent and experienced graduates, physiotherapists with low and high levels of training and physiotherapists working in private practice and hospital settings. METHOD: A survey was sent to 230 physiotherapists working in hospitals and in private practice. One hundred and twenty-four were completed and returned. RESULTS: Although 69.4% of respondents said they frequently (at least monthly) read research literature, only 10.6%, 15.3% and 26.6% of respondents, respectively, searched PEDro, Cochrane and Medline or Cinahl databases frequently, and only 25.8% of respondents reported critically appraising research reports. Recent graduates rated their evidence-based practice skills more highly than more experienced graduates, but did not perform evidence-based practice tasks more often. Physiotherapists with higher levels of training rated their evidence-based practice skills more highly, were more likely to search databases and to understand a range of evidence-based practice terminology than those with lower levels of training. Private practice and hospital physiotherapists rated their evidence-based practice skills equally and performed most evidence-based practice activities with equal frequency. CONCLUSIONS: Respondents had a positive attitude toward evidence-based practice and the main barriers to evidence-based practice were time required to keep up to date, access to easily understandable summaries of evidence, journal access and lack of personal skills in searching and evaluating research evidence. Efforts to advance evidence-based practice in physiotherapy should focus on reducing these barriers.

Adult↗
PubMed2004

Physiotherapy in Parkinson's disease: utilisation and patient satisfaction.

To examine the quality and quantity of physiotherapy care in Parkinson's disease (PD) in the Netherlands, postal questionnaires were sent to 300 PD patients. Patients who had received treatment by a physiotherapist at some stage during the previous year were asked to give approval to contact their therapist. Subsequently, postal questionnaires were sent to 129 physiotherapists who had recently treated the patients that were identified in the first stage of the study. Completed questionnaires were returned by 235 patients and 99 therapists. Sixty percent of patients were currently treated by a physiotherapist, most of them for more than six months. Ninety-five patients had serious problems within at least one of the four core areas of physiotherapy practice in PD (posture, balance, gait, transfers) and were therefore regarded as requiring referral to physiotherapy. Yet, 41% of them received no treatment at the time of enquiry. On the other hand, 75 patients had no serious problems within these core areas, yet half of them currently received treatment. The main goals for treatment were improvement of gait, general physical condition, posture or balance. Treatment mainly comprised active exercises. 60% of patients were treated by therapists without specific interest or education in PD. Most patients were presently satisfied with the treatment, but 11% had previously changed to another therapist because of dissatisfaction. In the Netherlands, referral rates of PD patients to physiotherapy are high and treatment duration is lengthy. Referral seems, to some extent, arbitrary. Scientific evidence for the effectiveness of physiotherapy in PD remains limited.

Aged↗
PubMed2004

Patterns of chest physiotherapy in Australian Intensive Care Units.

PURPOSE: The aim of this study was to identify the availability of physiotherapy services in Australian Intensive Care Units (ICUs) and articulate the roles that physiotherapists and nursing staff play in the provision of chest physiotherapy. MATERIALS AND METHODS: Telephone interviews with 71 clinical nurse managers and 6 physiotherapists of adult public Australian ICUs were undertaken. A structured interview schedule was developed from a review of the literature and a panel of experienced ICU clinicians and researchers to establish the frequency, components and personnel involved in the provision of chest physiotherapy. RESULTS: Almost 90% (n = 67) of ICUs had physiotherapists available during the week but over 25% (n = 22) had "on-call" service only on weekends. Less than 10% had weekday (n = 7) or weekend (n = 6) evening physiotherapy coverage. While nurses were involved in the provision of all aspects of chest physiotherapy, physiotherapists were primarily involved in airway suctioning, percussions, vibrations, positioning, and mobilization. CONCLUSIONS: The provision of chest physiotherapy services is often shared between physiotherapists and nurses, however, the actual therapies provided appears to vary depending on the provider. While strong evidence for chest physiotherapy procedures is lacking, the widespread use in the ICU suggests that it is an ideal setting for undertaking clinical research.

Australia↗