CONCEPTS - MISCONCEPTS IN ELECTROTHERAPY

I remember one day I was examining a patient with back pain and trying to test my post graduate student with her logical thought process regarding the pain management. To my shock and surprise, she said that she would not prefer any electrotherapy modality because none of the evidences support them. I was speechless. I did not know how to react. This is a routine discussion amongst Physical therapist regarding the use of Electrotherapy modalities. I am sure majority of us would say since evidences are tricky. Post graduate students must not talk about that in examinations as guided by few seniors to their juniors. But the same seniors will not fail to use multimodality approach in their clinics

courtesy-www.electrotherapy.org

 

In a blind run after evidence based practice, modern therapist fail to understand the concept of clinical expertise and clinical experience based practice. And in India, Electrotherapy still stands as one of the most important treatment option which can keep patient trusting you.

CLINICAL REASONING

By favouring the use of Electrotherapy, I dont favour multimodality approach. I strongly recommend accurate clinical assessment. Identifying the culprit structure and applying the electrotherapy modality accordingly. Each modality has its own specific indications and its specific dosimetry. One may not be inter changeably used with another unless indicated. Therapists make mistake in using them. Absence of proven guidelines is considered guilty for this. But standard textbooks do give clear cut guidelines.The dos and the donts. UNLESS YOU IDENTIFY THE STRUCTURE AT FAULT AND DECIDE THE MODALITY ACCORDINGLY WITH THE ACCURATE DOSE PARAMETERS, ALL MODALITIES WILL BE FELT SAME. As rightly said IGNORANCE IS BLISS

My piece of suggestion, just give THE MODALITY - one modality which can give effect to the target tissue and it will definitely give effects

WHY ARE EVIDENCES LACKING

We have heard Physiotherapists always saying evidences are lacking or controversial regarding the use of electrotherapeutic modalities. And blindly following that we keep on saying not to use. But have we ever thought why is it so that these are clinically so useful, yet why are the evidences controversial ?

1. Our researches have outcome measures as VAS, NRS or some other pain scale or any functional scale. We hardly go for biochemical analysis pre and post modality. Even the developed country researches on electrotherapy lack biochemical analysis. Or there are naive researches with biochemical analysis which as a result will reduce  the level of evidence of that study or make a study less reliable. As a result, we cannot consider the results of that study standard because whatever the outcome measures considered here are patient based which are more or less subjective. In absence of serum or biochemical analysis the objectivity of the study is reduced. As a result studies become controversial
2. Majority of the studies done for Medium and Low frequency currents are done for mechanically induced pain or are done on animals. The chemical changes taking place in such instances are different than those during injury process and during chronic pain cycle where centrally mediated certain unknown pathways come into play. Studies lack in this aspect.
3. Due to strict Insurance and Medico-legal policies and Type I and II skin in Western  population, it becomes risky to apply high frequency modalities like shortwave diathermy or microwave diathermy.These patients are at the risk of burns and skin cancer. Hence researches on this population is lacking. As a result moderate to good level evidences are lacking for high frequency electromagnetic radiation modalities like SWD, MWD etc. Since western countries dont use these modalities, and lack of research there, Indian Physiotherapists blindly follow this citing lack of evidence. Skin type of Indian population is mainly Type III or IV and are at a lesser risk of burns or skin cancer. We at India can definitely do research and establish the reliability of these modalities before using or discarding them. Because in India, even today there is a myth in common people that if you dont give them heating modality, they will not feel better. And so even for placebo, you need to give some modality

I dont say ONLY Electrotherapy works. NOTHING CAN REPLACE GOOD HANDS ON SKILLS AND PROPERLY EXECUTED MANUAL THERAPY. But whatever said and done, electrotherapy stands as an important adjunct to Manual therapy even today in Indian population.

People may feel that it is USELESS TO CONDUCT OR ATTEND SEMINARS ON CLINICAL APPLICATION OF ELECTROTHERAPY. Textbooks can teach theory. BUT IT TAKES CREDENTIALITY, CREDITABILITY AND EXPERIENCE OF SENIOR TEACHERS TO TEACH CLINICAL SCENARIO AND MAKE STUDENTS EXECUTE IT IN THEIR CLINICS. AT TIMES THIS CAN BE PROFESSIONAL UPLIFTMENT OR CAREER GROWTH. ONE NEEDS TO THINK OUT OF THE BOX