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PHYS THER
Vol. 87, No. 11, November 2007, p. 1558
DOI: 10.2522/ptj.2007.87.11.1558.1
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Letters and Responses

On "A survey of therapeutic ultrasound..." Wong et al. Phys Ther. 2007;87:986–994.


Wong and colleagues1 make the case that clinical expertise is useful for guiding decision making in the absence of higher levels of evidence. Although this is certainly true, it doesn’t readily apply in the case of therapeutic ultrasound as traditionally used by physical therapists. Repeated studies (including Cochrane reviews on ultrasound use for virtually every musculoskeletal condition managed by physical therapists, eg, van der Windt et al,2 Brousseau et al,3 and Welch et al4) have failed to find a benefit. These papers have not offered a glimmer of a hope that even a small subgroup may exist for whom therapeutic ultrasound is beneficial.

The fact that physical therapists still widely use therapeutic ultrasound for patients with musculoskeletal conditions is much more likely attributable to the 15- to 20-year "evidence gap" that exists in health care and to the fact that third-party payers continue to reimburse for mostly worthless interventions such as therapeutic ultrasound. In our fee-for-service health care system that rewards doing procedures without regard for whether the patient benefited, I am not an optimist that much will change. Surveys like this remind me that, to paraphrase Delitto,5 "we are still not listening."

John D Childs

JD Childs, PT, PhD, MBA, OCS, FAAOMPT, is a Physical Therapist at US Army-Baylor Doctoral Program in Physical Therapy, San Antonio, Tex


  Footnotes
 
This letter was posted as a Rapid Response on August 7, 2007, at www.ptjournal.org.

References

  1. Wong RA, Schumann B, Townsend R, Phelps CA. A survey of therapeutic ultrasound use by physical therapists who are orthopaedic certified specialists. Phys Ther. 2007;87:986–994.[Abstract/Free Full Text]
  2. van der Windt DA, van der Heijden GJ, van den Berg SG, et al. Ultrasound therapy for acute ankle sprains. Cochrane Database Syst Rev. 2002;(1):CD001250.
  3. Brosseau L, Casimiro L, Robinson V, et al. Therapeutic ultrasound for treating patellofemoral pain syndrome. Cochrane Database Syst Rev. 2001;(4):CD003375.
  4. Welch V, Brosseau L, Peterson J, et al. Therapeutic ultrasound for osteoarthritis of the knee. Cochrane Database Syst Rev. 2001;(3):CD003132.
  5. Delitto A. Clinicians and researchers who treat and study patients with low back pain: are you listening? Phys Ther. 1998;78:705–707.[Abstract/Free Full Text]

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This Article
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Rapid Responses are posted
Right arrow Alert me if a correction is posted
Services
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Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
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Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Childs, J. D
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Childs, J. D
Related Collections
Right arrow Physical Agents/Modalities
Right arrow Evidence-Based Practice
Social Bookmarking
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Copyright © 2007 by the American Physical Therapy Association.