Preface

Physical therapists, athletic trainers, occupational therapists, physical therapy assistants, occupational therapy assistants, physical therapy aides, and chiropractors use a wide variety of therapeutic techniques in the treatment and rehabilitation of their patients. A thorough treatment regimen often involves the use of therapeutic modalities. At one time or another, virtually all clinicians make use of some type of modality. This may involve a relatively simple technique such as using an ice pack for an acute injury or more complex techniques such as the stimulation of nerve and muscle tissue by electrical currents. When used as an adjunct to appropriate therapeutic exercises, therapeutic modalities can potentially be useful tools in the rehabilitative process and may enhance the patient’s chances for a successful treatment outcome. To best achieve an optimal patient outcome, clinicians must incorporate evidence-based practice into their clinical decision making. Evidence-based practice involves making decisions about the clinical care of individual patients based on the current best-available clinically relevant research in the professional literature either from the basic sciences or medicine or from patient-centered outcomes research. Additionally, patient care decisions must also integrate the expertise of the clinician acquired through clinical experience and practice while focusing on individual patient values and preferences.

The sixth edition of Therapeutic Modalities in Rehabilitation will attempt to present the basic science and the current best available evidence from systematic reviews for each different type of modality and allow the clinician to make his or her own decision as to which will be most effective in a given situation to achieve optimal patient outcomes. Some recommended protocols developed through the experiences of the contributing authors will be presented.

The following are a number of reasons why this text should be adopted for use.

The purpose of this text is to provide an evidence-based but practically oriented guide to the use of therapeutic modalities for the practicing clinician and their students. It is intended for use in courses where various clinically oriented techniques and methods are presented.

The chapters in this text are divided into six parts. Each chapter discusses (1) the physiologic basis for use, (2) clinical applications, (3) specific techniques of application through the use of related laboratory activities, (4) relevant individual case studies for each therapeutic modality, and (5) the current best-available evidence from systematic reviews and meta-analyses for each different type of modality.

Part I—Foundations of Therapeutic Modalities begins with a chapter that discusses the scientific basis for using therapeutic modalities and classifies the modalities according to the type of energy each uses. Guidelines for selecting the most appropriate modalities for use in different phases of the healing process are presented. A chapter that deals specifically with the role of therapeutic modalities in wound healing is followed by a discussion of pain in terms of the neurophysiologic mechanisms of pain and the role of therapeutic modalities in pain management.

Part II—Electrical Energy Modalities includes detailed discussions of the principles of electricity, and electrical stimulating currents, iontophoresis, and biofeedback. A chapter that deals with the principles of electrophysiologic evaluation and testing is included. Although this is not a therapeutic modality per se, electrophysiologic testing is commonly taught in classes that cover electrical modalities and thus the decision was made to include this topic in this text.

Part III—Thermal Energy Modalities discusses those modalities that produce a change in tissue temperatures through conduction or convection, including thermotherapy and cryotherapy.

Part IV—Sound Energy Modalities discusses those modalities that utilize acoustic energy to produce a therapeutic effect. These include therapeutic ultrasound and a lesser known modality, extracorporeal shockwave therapy.

Part V—Electromagnetic Energy Modalities includes chapters on both the diathermies and light therapies.

Part VI—Mechanical Energy Modalities includes chapters on traction, intermittent pneumatic compression, therapeutic massage, and vibration therapy.

This text discusses various concepts, principles, and theories that are supported by scientific research, factual evidence, and previous experience of the authors in dealing with various conditions. The material presented in this text has been carefully researched by the contributing authors to provide the best-available evidence for incorporating a particular modality in a specific injury situation. Additionally, the manuscript for this text has been carefully reviewed by educators, researchers, and practicing clinicians who are considered experts in their content area to ensure that the material reflects factual and current concepts for modality use.

Certainly, therapeutic modalities used in a clinical setting can be useful tools for the clinician. This text provides a comprehensive resource that should be used in student instruction on the theoretical basis and practical application of the various modalities. It should serve as a needed guide for the student who is interested in knowing not only how to use a modality but also if that particular modality is most effective in a given situation.

The authors who have contributed to this text have a great deal of clinical experience. Each of these individuals has at one time or another been involved with the formal academic preparation of the student clinician. Thus, this text has been directed at the student who will be asked to apply the best-available evidence as the basis for modality use to the clinical setting.

Several other texts that discuss the use of selected physical modalities in various patient populations are available. This is the most comprehensive text on therapeutic modalities available in any specific discipline.

The aids this text uses to facilitate its use by students and instructors include:

Objectives These goals are listed at the beginning of each chapter to introduce students to the points that will be emphasized.

Figures and Tables Essential points on each chapter are illustrated with clear visual materials.

Summary Each chapter has a summary that outlines the major points covered.

Clinical Decision-Making Exercises The scenarios help the clinician develop decision-making abilities about how a specific modality may best be used clinically.

Review Questions Designed to help the student review the material presented in each chapter by answering a series of thought-provoking questions.

Self-Test Questions A set of true/false and multiple-choice questions is provided in each chapter to help the student prepare for a written examination and to assess student comprehension.

Glossary of Key Terms Each chapter contains a glossary of terms for quick reference.

References A list of up-to-date references is provided at the end of each chapter for the student who wishes to read further on the subject being discussed.

Case Studies A series of clinically based case studies are presented to enhance student understanding of how these modalities may be applied to a specific patient.

Lab Activities Lab activities are included to guide the student through the setup and application of the various modalities.

Appendices A chart of trigger points and a comprehensive list of manufacturers of therapeutic modality equipment are provided.

There are a wide variety of laboratory activities found throughout this book.

Theory, biophysical principles, and range of potential clinical medicine applications for the various physical agent modalities will be found in this text. The activities are intended to provide the student or interested reader with a systematic and sequential method of completing a therapeutic modality application. The initial performance of a therapeutic procedure should proceed in a logical stepwise fashion. They are structured to allow both the instructor or supervisor and the student the ability to assess competency in a partial or complete fashion culminating in the independent ability to safely and effectively provide a therapeutic modality treatment.

Each therapeutic modality application has a separate sequential checklist. Similarities will be noted in certain aspects of treatment application and completion. Space is provided for up to three separate instructors/supervisors to “sign off” (initial and date) the successful completion and demonstration of each element of the complete application. A Master Competency Check list is provided to document the successful completion of the individual therapeutic modality checklist and when the student is deemed competent to independently provide that treatment. This system documents the acquisition of skills necessary for effective physical agent modality application and ensures accountability by the student and instructor/supervisor to patients and other concerned parties.

Competency in the skillful application of therapeutic modalities is gained through diligent and frequent practice. Use of these activities in the manner described will guide the user in productive practice and successful acquisition of essential skills. Students are encouraged to practice each of the procedures on themselves first, thereby gaining an appreciation of the sensations associated with that particular modality. Further practice with a variety of lab partners will result in the development of the desired competence and confidence with any manufacturer’s equipment.