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PHYS THER
Vol. 87, No. 11, November 2007, p. 1559
DOI: 10.2522/ptj.2007.87.11.1559.1
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Letters and Responses

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


The equivocal nature of the evidence supporting how most physical therapists use ultrasound is longstanding. Amusat's response provides no reasons why we should keep on re-weighing the evidence. Systematic reviews have already done this for at least a decade, so the time for this approach has surely passed.

We are an evidence-based profession. Therefore, we modify practice in response to a sufficiently convincing body of evidence. The evidence on how we use ultrasound has not been supportive of many practices for too long already. In his response, Childs provides possible reasons why—despite the evidence—ultrasound continues to be used so often.

What do we know? The ultrasound dosages that most therapists apply are ineffective for most uses examined to date. Existing evidence supports some uses under limited conditions,1–3 but I am unaware of published replications of these interventions. Heat and electrical stimulation offer more effective interventions that can address many patient needs.

We need to rethink how we use ultrasound. As I said in my invited commentary, "Ultrasound offers many clinical users considerable potential."4 This is not a contradiction. There is a growing body of evidence regarding longer-duration applications of low-intensity pulsed ultrasound (LIPUS). This is where we should put our efforts now, continuing the work of researchers such as Warden et al5 and establishing the contributions that LIPUS may offer our patients. Consider also the growing use that physical therapists make of diagnostic ultrasound.6–10 These, rather than the traditional uses made of ultrasound, are the future.

Val J Robertson

VJ Robertson is a Professor at the University of Newcastle, NSW, Australia


  Footnotes
 
This letter was posted as a Rapid Response on September 11, 2007, at www.ptjournal.org.

References

  1. Ebenbichler GR, Resch KL, Nicolakis P, et al. Ultrasound treatment for treating the carpal tunnel syndrome: randomised "sham" controlled trial. BMJ. 1998;316:731–735.[Abstract/Free Full Text]
  2. Ebenbichler GR. Author’s reply to letter to the editor. BMJ. 1998;317:601.[Free Full Text]
  3. Ebenbichler GR, Erdogmus CB, Resch KL, et al. Ultrasound therapy for calcific tendinitis of the shoulder. N Engl J Med. 1999;340:1533–1538.[Abstract/Free Full Text]
  4. Robertson VJ. Invited commentary. [RE: A survey of therapeutic ultrasound use by physical therapists who are orthopaedic certified specialists.] Phys Ther. 2007;87:995–999.[Free Full Text]
  5. Warden SJ, Fuchs RK, Kessler CK, et al. Ultrasound produced by a conventional therapeutic ultrasound unit accelerates fracture repair. Phys Ther. 2006;86:1118–1127.[Abstract/Free Full Text]
  6. Bo K, Sherburn M. Evaluation of female pelvic-floor muscle function and strength. Phys Ther. 2005;85:269–282.[Abstract/Free Full Text]
  7. Chipchase L, Williams M, Robertson V. A survey of electrophysical agents’ curricula in entry-level physiotherapy programs in Australia and New Zealand. New Zealand Journal of Physiotherapy. 2005;33:3447.
  8. Henry SM, Westervelt KC. The use of real-time ultrasound feedback in teaching abdominal hollowing exercises to healthy subjects. J Orthop Sports Phys Ther. 2005;35:338–345.[Web of Science][Medline]
  9. Hodges PW. Ultrasound imaging in rehabilitation: just a fad? J Orthop Sports Phys Ther. 2005;35:333–337.[Web of Science][Medline]
  10. Whittaker JL, Thompson JA, Teyhen DS, Hodges PW. Rehabilitative ultrasound imaging of pelvic floor muscle function. J Orthop Sports Phys Ther. 2007;37:489–498.

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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
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Google Scholar
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Right arrow Search for Related Content
PubMed
Right arrow Articles by Robertson, V. J
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Right arrow Physical Agents/Modalities
Right arrow Evidence-Based Practice
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