AUSTRAliAN PHYSIOTHERAPY

David LindsayJonathon DearnessCarolyn RichardsonAndre ChapmanGeoffrey Cuskelly

ORIGINAL ARTICLE

A survey of electromoda.1ityusage in privatephysiotherapy practices

This study aimed to examine ownership andusage frequenciesafeIeetrotherapeutiemodalities typically found in privatephysiotherapy practices in Brisbane. Thesurveyincluded 73 practices, representing 70 per centof the selected sample. Results revealed thatultrasound units were used more "frequently"than any othermodality.Transcutaneouselectrical nerve stimulation. and interferentialunits were aIso used extensiveIy. Short-wavediathermy units were found in more clinics thanany other heating modality. Transcutaneouselectrical nerve stimulation was the onlymodaJity to demonstrateasignificantdifference(p<. 0.05) in "Frequent" usage betweenpractitioners aged under 31 and those 31 andolder. Overall, the majority of respondents(77.5 per cent) trained at the University ofQueensland, afact which may have influencedthe identified trends.[Lindsay D, Dearness J,Richardson Cet al: Asurvey of electromodality usage in privatephysiotherapy practices. Australian Journal ofPhysiotherapy 36: 249-256 1 1990]

KeyWords: Electrical stimulationtherapy; Physiotherapy; Short­wave therapy; TENS; Ultrasonictherapy.

David Lindsay, BHMS,MSc, BPhty, is.8 cl inicaland research physiotherapist at the Universityof Calgary Sport Medicine Centre, Canada.Jonathon Dearness, BHMS, BPhty; Andrew

. Chapman, BPhty; and Geoffrey CuskeHy, BPhty;are practising physiotherapists.Carolyn Richardson, BPhty(Hons), PhD, isalecturer in the Department of Physiotherapy,University of Queensland, St Lucia, 4067.Correspondence: Dr Richardson

he use of electrotherapeuticagents is an important componentof physiotherapists' treatment

regimes. Research by Dennis (1987b)suggests that up to 61 per cent ofpatients' clinical time is devoted toelectrotherapy-type treatments. Bydefinition, electrotherapy is thetherapeutic application ofelectricity(Thomas 1983). Dennis (1987b) alsoincludes heat modalities andacupuncture" in this category. For thepurposes of this study, electrotherapyagents (or electromodalities) refers totherapeutic heating agents .aswell asmodalities whose physiological effect isspecifically derived from electricalmeans. Motorized traction andacupuncture were not included.

Electrotherapy has been incorporatedip treatment programs for .decades.Diathermy was reportedly used inGermany in the late 1920s (Kloth1986), while the .medical introductionof ultrasound occurred in the late1930s (Ziskin and Michlovitz 1986).Wadsworth and Chanmugam (1988)comment that the past few years haveseen considerable change in therapists'views ofeleetrotherapy. They warnthat, while change is inevitable anddesirable, it should be based onscientific evidence and not on fashion..At present, the investigation oftrendswithin the field of electrotherapy islimited by a lack ofscientific reportingof modality usage.

Recent years have seen a proliferationof electromodality machines comingonto the market (Ide 1990)..Unfortunately, there has been no

extensive scientific investigation intofactors such as the therapeuticeffectiveness, reliability and safety (forboth operator and patient) of theelectromodalities (Wadsworth andChanmugam 1988, Ide 1990). Thislack ofscientific validation is likely toresult in other factors influencingclinicians' preferences for using orpurchasing modalities. These factorsmay include equipment cost,therapists' familiarity with modalitiesand, perhaps, marketing strategiesutilised by manufactures.

Overall, it seems likely that selectionof electromodalitiesmay varyconsiderably within a population ofclinicians. It was the intention of thisstudy to determine the frequeneyofuseofavariety of electromodalitiesavailable in private practicesthroughout the City of Brisbane. Toinvestigate the factors which couldhave influenced patterns of use, we alsocollected information about the typesof special clinical interests identified bypractitioners, clinic patient loads,practitioners' ages, and institutions atwhich practitioners were trained.

Review of literatureExtensive amounts of literature have

been published regardingelectromodality ownership and usagecharacteristics. Completed studies haveoften focused on one electromodality.Paxton (1980), in a nationwide surveyof 303 American physiotherapydepartments, investigated the clinicaluses of transcutaneous electrical nerve..

From Page 249stimulation (TENS). Approximately 68per cent of the 196 respondents usedTENS to relieve pain in a variety ofacute and chronic conditions. Most ofthese clinicians were satisfied with theeffectiveness of the modality. Of the69 respondents who did not useTENS, nine had previously used it buthad since stopped. Reasons fordiscontinuation ofusage includeddissatisfaction with its effectiveness,time limitations, and non-prescriptionofTENS treatment by physicians.

In aCanada....wide survey ofultrasound (US), shortwave diathermy(SWD) and microwave diathermy(MWD) devices (DHW 1980a, DHW1980b), it was reported that out of atota10f JOO physioth~rapy practicescontacted, 119 used US, 95 used SWDand 22 used MWD. Since not all ofthe 300 clinics returned thequestionnaire, the authormathematically.estimated that anupper limit of 74 percent of practicesused US modalities. No suchcalculations were made for SWDorMWD.

Robinson and Snyder-Mackler (1988)surveyed the usage characteristics ofeight types of clinical electricalstimulation. Ultrasound was alsoincluded for comparison purposes.Four hundred and ninetyquestionnaires were distributed to 370facilitiesaffiliated with Ithaca Collegeand Temple University in the UnitedStates. The results of the studyrevealed that US and TENSstimulation were each available to alarge proportion of clinicians (94 percent and 92 per cent respectively).However, US tended to be used moreoften with 64 per cent of cliniciansindicating they used it more than onceper day (compared to 33 per cent forTENS). High voltage stimulation wasavailable to 78 per cent of therapistsand used more than once per day byapproximately one-third of these.Only a small portion of respondentsindicated that they used classical lowvoltage alternating or direct currentsInore than once per day (8 per cent and2 percent respectively). Exactly 90 percent of therapists reported that they

o RIG IN A l ART let E

did not use interferential modalities.In an abstract published prior to their

1988 study, Robinson and Snyder­Mackler (1986) also reported that UScombined with electrical stimulationwas used by 50 per cent of the surveyrespondents.

Ter Haar et a1. (1988) investigatedUS usage by physiotherapists inNational Health Service (NHS)hospital departments and privatepractices in the United Kingdom.Replies were collected from 204 NHSdepartments and 191 private practices.Included within the authors' resultswas the observation that, while lOOpercent ofprivate practitioners used US intheir clinics, it was used in only 81 percent of NHS departments. Thesefigures were not discussed by theauthors.

Information derived from our studywas expected to be of value topractising physiotherapists,electromodality manufacturers andsuppliers and .educational institution.s.We hypothesized that results woulddemonstrate a wide range ofelectromodalityownershipand usagefrequencies but also that definitetrends, based on factors listedpreviously, would be evident.

MethodThe survey questionnaire was mailed

to all private physiotherapy practiceswithin Brisbane's city limits. A total of105 clinics were contacted. The surveyinstrumentconsistedofa letter ofintroduction, instructions forsuccessfully completing thequestionnaire, and the questionnaireitself. The questionnaire required bothclosed and open-ended responses fromparticipants. A representative fromeach clinic was asked to indicate whichelectromodalities were available in theclinic and how often each was used.Five usage frequency categories weredefined:Frequently -'- used at least once per

dayRegularly --- used at least once per

week but less thanonce per day

Minimally -,- used more than once

AUSTRAlIAN PHYSIOTHERAPY

per month but lessthan once per week

Rarely-,- used once per·monthor less

Don't own --- did not own nor haveimmediate access to

In addition, participants were askedto indicate reasons why they used amodality "Frequently" Of why theywould notpufchase a modality. Open­ended comments were used to answerthese questions. A final series ofquestions (which were optional) soughtbackground infonnation fromparticipants. Practitioners were askedto list clinic special interests (if any),clinic patient load per week, the age ofthe practitioner(s) responsible forpurchasing modalities and, finally, theinstitution at which they received theirtraining.

Data collection involved bothindirect (mail) and direct (personalcontact) methods. The surveyinstrument was mailed to allpopulation sample members.Approximately two weeks after surveydistribution, practitioners werecontacted by telephone by a memberof the research team. Telephonecontact permitted the researchers todeal with any problems encountered bythe practitioners and to arrange for thereturn of completed questionnaires.Subject responses were manuallyrecorded and tabulated on appropriatemaster sheets. Chi-square statisticalanalyses were performed on thecollated raw data to test the userfrequeneydistribution for eachmodality.

ResultsCompleted questionnaires were

collected from 70 per cent of the 105clinics originally surveyed. Whencompared to other surveys involvingmailed questionnaires tophysiotherapists (Dennis 1987), this isan acceptable response. The datacollected·can be regarded as beingrepresentative of electromodality usagein private practice within the City ofBrisbane.

Figures.! and 2 represent a profile ofthe practitioners and practices

AUSTRAliAN PHYSIOTHERAPY o RI GIN A1 ART I CLE

Age group

Figure 1Age distribution of respondents

2018

1614

CI).... 124)...0 10E

8:)

Z 64

20

""¢I .-- .-- .-- N

0 . I

-.0 "0

'" 0 ~ .l'..

Patient loads

Figure 2Distribution of weekly clinical patient loads.

L-.,---.-.-..-....-,~-------'----------'---~~~~~~~~~-------'---~ __~ ,_~_~~--~

surveyed. The age distribution of therespondents (Figure 1) reveals thatpractitioners' ages ranged from 24 to64 years, with a mean age of 36 years.The weekly patient loads of clinics(Figure 2) ranged from two to 350 perweek with an average of 117 per week.

Additional information gained fromrespondents revealed that sportsphysiotherapy (20 percent ofrespondents) and manipulativephysiotherapy (18·per cent ofrespondents) were the most popularspecial interest areas of practice.However, 33 per cent failed to answerthis optional question. It was furthernoted that 77.5 per cent of respondentsreceived their training at theUniversity of Queensland, while theremaining 22.5 per cent were fairlyequally distributed between otherschools in Australia, New Zealand andEngland.

Table 1 contains informationregarding the ownership and usagecharacteristics of electromodalities. Aone-way Chi-square test (Rothstein1985) was applied to the usagefrequeneydistributions for eachmodality. Non-significant differences(using thep <0.05 level) existed for USwith electrical stimulation, TENS,Faradic-type, Diadynamic, pulsedSWD,pressure pump and biofeedback.A two~way Chi-square (Rothstein1985) was used to compare the"Frequent" use of each modality byrespondents 31 years and older withthose under 31 years. A statisticallysignificant difference between groupswas detected only for the TENSmodality (Chi-square, 1 df : 5 .37,P<0.05).

Tables 2 and 3 categorise the reasonsidentified by practitioners for"Frequently" using or not purchasing amodality.

DiscussionBased on the results displayed in

Table 1, it appears thatphysiotherapists operating Brisbane'sprivate practices incorporate a widevariety of electromodalities in theirtreatment regimes.Furthermore, therespective frequencies of use of these ..

----'-~,--.-,----~~~~~~~-~

From Page 251different modalities vary considerably.Possible implications and reasons forthe ownership and usage patternsidentified are presented below.

UltrasoundUltrasound machines were found in

more physiotherapy.clinics (100 ·percent of clinics surveyed) and used more"Frequently" (93 per cent of clinicsused them at least once per day) thanany other modality. These findingswere similar to those ofTerHaar et al(1988) and Robinson.and Snyder­Mackler (1988) but differed from theestimated totals of the CanadianDepartment of Health and Welfare(1980b).

Physiotherapists seem to placeconsiderable importance on the use ofUS in their treatment regimes. Itwould appear that one of the.primereasons for this is the modality'sperceived effectiveness. Forty-one ofthe 68 respondents using US"Frequently" listed effectiveness as themain reason for choosing thismodality. Other reasons included easeof application (eight responses) andsafety (six responses).In light of the apparent popularity of

US demonstrated in this study andothers, it is surprising that there is stilllittle objective reporting of its clinicalefficacy (McDiarmid and Burns 1987).The positive subjective opinionssupporting the clinical effectiveness ofUS, while helpful in justifying itscontinued use, emphasise the need todevelop a stronger scientificunderstanding.

In contrast to the popularity of US inphysiotherapy treatments, combinedUS with electrical stimulation wasfound in only 20 per cent of clinics andused "Frequently" in just 3 per cent.These totals differ considerably fromthose qf Robinson and Snyder-­Mackler (1986) who reported that 50per cent of their 221 Americanrespondents used combined US withelectrical stimulation. This differenceillustrates possible differences in usagefrequencies between differentcountries.

o RI GI NA 1 ARTICLE

Electrical stimulationIn terms of ownership, more clinics

possessed dedicated TENS units thanany other type of electrical stimulator.In fact, TENS ranked second only toUS in terms of ownership percentage(91.5 per cent versus 100 per cent)Co--incidentally, Robinson and Snyder­Mackler (1988) also reported that 92per cent of clinicians in their surveyhad access to TENS. The Chi-squareanalysis ofthe distribution ofresponsesfor TENS usage revealed nosignificant differences (p< 0.05)between the various categories. Sincethe effectiveness of TENS for painrelief is critically dependent onelectrode placement and applicationtechnique (WardsworthandChanmugam 1988),itisunderstandable that some therapistswould find this modality more effectivethan others. This could explain theusage distribution found in this survey.

Clinicians who.used TENS"Frequently" reported effectiveness asthe main reason (1·1 responses).Portability of the units was anotherimportant factor (five responses). Themain reason for not purchasing a unitwas the availability of other modalitiesto provide similar effects (threeresponses). In contrast to Paxton's(1980) study, no mention was made oftime restrictions within the clinicalsetting as a reason for not owning aTENS modality.

TENS was the only modality used"Frequently" significantly more often(p< 0.05) by physiotherapists under theage of31 years than by those 31 yearsand older. This finding was notunexpected, as TENS is a relativelynew concept in electrical stimulation,having been popularised in 1973 byShealy, and would be more familiar toyounger practitioners.

Although interferential (IF) trailedTENS in terms of the total number ofclinics owning each (85 per centcompared to 91.5 per centrespectively), IF tended to be usedmore often. Exactly 90 per cent ofclinics having access to IF modalitiesindicated that they used them at leastonce per day (versus 21 per cent forTENS). In contrast to the findings of

AUSTRAlIAN PHYSIOTHERAPY

this survey, Robinson and Snyder­Mackler (1988) reported that 90 percent of their respondents did not useIF, while only 3 per cent used it morethan once per day.

This discrepancy may be explained bythe fact that only 11 per cent of theirrespondents indicated they hadreceived adequate background trainingin IF. Robinson and Snyder-Mackler'sfindings· illustrate the influence ofeducational training on modalityselection.

The·strong support for IF shown bythe respondents in this survey appearedto be primarily due to its effectiveness,although ease of application was also afactor. Other authors have commentedon.similar characteristics as reasons forusing IF (Ganne 1976, Nelson 1981).Although small in total numbers, themain reason.listed for not owning anIF unit was cost (three responses).Overall, it appears that, if a clinic couldafford an IF unit, itis used often.

With respect to the remainder of theelectrical stimulators surveyed, highvoltage (HV)was the most popular. Atotal· of 45 per cent of clinics had accessto HV and 72.5 per cent oftheseclinics used it "Frequently". Thesetotals differ from those of Robinsonand Snyder-Mackler (1988) whoreported that 80 per cent of theirrespondents had access to HV whileapproximately one third of these usedit more than once per day.

In contrast to HV, faradic stimulatorswere found in 37 ·per cent of clinicsand used "Frequently" in just 3.5 percent of these. Faradic-type.(IT) anddiadynamic stimulators were found inonly a very small number ofclinics.

When asked to indicate reasons forusingHV "Frequently",mostpractitioners listed the modality'seffectiveness, especially for pain relief,swelling reduction and/or muscle re­education. Main reasons for notpurchasing faradic or IT modalitiesincluded an assessment that they werenot needed or that another modalitywith similar effects could be used.Most respondents indicated that theywere unfamiliar with diadynamiccurrents (13 responses) .

AUSTRAlIAN PHYSIOTHERAPY ORIGINAL ARTICLE

: ....... :....>.

....~ :>

:.:" >.':................:..

: ................:... : ........

"':.' .:.:.......: ..:....... : .... :::: ...... : < ..... : ........

........:..::. '::.'

....... >.: ...... .... .:'. :.....

..., .. ::.::::.:.... :'.' .....:..:.:::....: ":>. ..: :: '

:.:.: <>.. : :.: ::: ....• :> : : :.:..•..:..:: :.::: :..>.:••..: : : ::.::::: •.:.. ' <'»:<.MuW: l;I"'c .&. . \ . ·.c.••.· :: >:» : : :: ..:..

..... ...............•.•·.·Fren.. ,Uen:s u::z:."i·,~.. a,·...··•.,a,g,r~,a:rfMmim.,•.i;:,..:,:.:'a;::·cI~~~,.',:,'" ..~""'-",e .Ntm:~~rs=:s ..Fr:1-:~....•........•.••••. •.••... .~ 5~ RaL..(ifreS)!tiooeBts ofremond~nts ofoWItcrs

UltrasOund. 93 5.5 . ·1.5 .Q(r . 1~· ...•.... ··93

I.1"5vrilli Elec Stirn... .36 1..5 10 S02~ ..... · · ···1>1 r"..... :...:::..... ::.:. :: ,' : : :: ,t'T.J

, :. ....:.. : ...:........:..: ......

Tilble1 ..,: :......< .. ' . ' .. ,,,:

TENS ·:.:.: •. ·:.·.::· .• :.· : :: : ' ::: :.: ::..··..·..··.: ..·..'· 1.9.5, :Inte'rferentiaI- 7·6."TI~ L 1 >.....n1g.lJ,"V'();-tag,e.·: > : ,..: :.:: : :.:.:.: ), 3',Faramc ..... ..... .... ' l~$

Faratlic-type . . (fDiaclytiamig 1.5

3':2 2,0.5.··:: ::: :··.:: <·..<· : <::·:..:..•·..·:·<' ·iAF ·::., ':: ::::.::::: :..:::::..:: ..:::: :' ::::8 ~.5 ••'.<.:::'.. ::':..:•• > <·.:..<:.......>:..:: :< :..<191.. $..' : : :: :.... ......< 21 .4. 1.5 ",?: ' 15 8'$', 90:: ..

9.5··:,"·······: ..:.. :: ..:....::·..·::· ..·.... >:<···>··.. ·,··:·..:·:>:·:<·· ..·2~,5, 'D.,':" ',5'5' 45 72.5

,5~5 :8 . " ,',g,2",'- 63 373.5.3 3" ,'ff' ,91- :9·:::.··, :;,"' .. :.. : :.:::::.:.:::.::: : : : : : ::.::.:. ,0>3 ' ' :0 ' ,() 9.5~5 "4-.5 .........: 33 .5

'" ", ,,64-" ' '.' '.' ".' .. 'll6 ":',6-9. 1.4··:··:···::..··•·.. < ::: :::.'.:.. :: •.:: •..,> •....::.:.::.:: :<.·.. ····:·:·:·:::·:·::·:·:,2-:,6,:·' ..,: : :>: >:.: :::.>:., ::.:: :.:.>..:.:.., ':.•:..: ">, z-li5

76.5 2.3.5 :..: :.. 17.5

':0.0;:.,..•··•·..·:·»":::'.•::.•:,:<:•...• « <..<..•<.• , •. :- :•..» :.::-..:•.-..>"'::·:':·::':"::'··'68

, 1St$" '43:-33:-:-< . ' '7--9'

6-1<.5 . ;6ft ....:-.:-",45':- --, ,:- ... :-....... '39..5 ....

'--, J9:-~,5. 10.5',29, 9:-.5 :-.'

:.:'... ':':' .....'::.: .'.......

1.. ', .' (}..", "',8:CL5 '',' 2,.<5', " "." ,:'".1:",~.',.,' ,';,',' ,"""', --tiI"

" ,',<Z::.5,:,' ,,', ,:'5·::1'5" ' ,'-;,;8.,5",, "',' 'J:' '. ,:7.-:::" '," , 5-5 '

',' '. '.9:~,$ . ". ,': ' " ::. :rSt ,.', ,QO~..5

. 2.~5 "1H1LS',' " " j1 "

s~·:·::::·<·····:···············:..•·······..·:·::::·':·>:.: :: :.:::.:.,: >:.::..::: :: >:· :..,· ..::45 ·..·•· ..··<·..·•·..··<··>·>:<: ..:·······:: ..·: : :, l2~-S·,: '......... " .

. : .. :.'

Pulse-a SWIJ . 8..5 ,4-" 'M~'>~ L,t). , :2.5. ''BarRacks....... :....:... 4F2,.} Ii :Elec meat Pads 1-8, . 13"~"5 'Wax'Ilath .ft. " :1."'.", .Infrared. L.am)?> :.... 2~?, 2.'.5'"

":'. ',' .. ' '.",,',': ' ,",

.. ~ ',', , ,,', ,~,'"

Magnetic FielcI,,· ·..··::·:·:: ·>: ····:..>.:::·:..:,.·45;, :':,.>:>..: :.::.:.: :> <:..:.•:>..•.:: :.. : :::<.· ::·: ..·:4", ·.. <..:•....••...:.:.:::.: ::.: , .. >.:: ,,:>.-,::':.'::; :..':Lf ,', '"'' "', ":,". ,:3 ':','Presstire Pump ,7.. 8 ' ' ':%' . , 4,",'Biofeedback ..... :.... 4- .'.::>'. 7:, 5..~5 0/.'Laser :::.: .. <}.5, 0 .3 ' 4-Ultra violet 3 -0 0 ,'7 '

:8-3:~5 1.(5.5 58.5, '90:- ' ... :-...... 10 28.5

':- ..-, , ..... ........

. '<

':.'.: ....

<.. ': ': ..<.....<... ::«:.<:..::-.: .. ::.: .......:::: ......... :.< .. :..:, ....

....... : > ::- .. : : >: :.. .-.•. : :..:.:::-:'-:,.: :.:.:..-.:..:.•.:.: ::. .-: :- ......•........•.> :: '-:, ::.: ...•.. .-.:.:..::.:.-.. :,.- :.:......• :- .....• :- ...•..•... :-.-.:: .. : ::..-.- ::.:••... <.. :.::::.:: ::.: : :..:-: :.: , : , :.-.. :.: :.:: ..

Therapeutic heatTwo categories oftherapeutic heat­

diathermy and superficial heatmodalities - were identified.Diathermy modalities included SWIJ,pulsed SWIJ, and MWIJ. Short wavediathermy was found in more clinics(66 per cent) than either MWIJ (33per cent) or pulsed SWIJ (19~5 percent)~ It was interesting to note that,in clinics owning a MWIJ unit, 79 percent used it "Frequently". Thiscompared to 68 per cent for SWIJ and43 per cent for pulsed SWIJ.

There have been reports (outsideAustralia) of unwise and potentiallyhazardous treatment practices usingdiathermy modalities (Delpizzo andJoyner 1987)~ The radiation hazards of

SWIJ have also been investigated(Delpizzo and Joyner 1987). It ispossible that such adverse publicitycould influence the popularity of thesemodalities. However, comparing thenumber of clinics using therapeuticheating agents revealed that SWIJ wasfound in more clinics than hot packs(61.5 per cent), electric heat pads (45per cent) or infra-red lamps (29 percent)~

An examination of the reasons givenfor using SWIJ "Frequently" revealedthat effectiveness, especially fortreating deep conditions, was the mostcommon response~ Those clinics notpossessing a SWIJ unit listed costfactors (six responses), the use ofanother modality for similar effects

(five responses), and safety concerns(four responses). It was not clearwhether safety concerns pertained tothe patient, the operator or both. Inthe case ofMWIJ, effectiveness (11responses) and ease of application(seven responses) were the mainreasons listed supporting its"Frequent" use. Safety concerns (13responses) were most often listed as thereasons for not purchasing thismodality~ The most prevalentresponse listed in Table 3 for non-useof pulsed SWIJ was the relatively highcost of this modality (13 responses).

Superficial heat modalities includedhydrocollator heat packs (HHP),electric heat pads (EHP), infra-red

ORIGINAL ARTICLE AUSTRAliAN PHYSIOTHERAPY

3 5 27 2 5 126 3 1 4

1

Effectivemuscle muscle· musclerelax. educ. deep heat safe

RESPONSES

1

77

2

4

83

Otherease of

portable application

2

132

6

111

52

res:POlrtt:le~nt$,Us:ing electromodalities

from Pagelalnps (IRL) and wax baths (WE).Table 1 revealed that HHP were foundin tnore clinics and used more"Frequently" than either EHP, IRLorWE. Wax hathsand IRL, while foundin relatively high numbers of clinics(39,,5 per cent and 29 per centrespectively), tended to be used"Rarely" in Inostof these clinics.

The Inain reason given byrespondents for using superficial heat111odalities"Frequently" was theirapparent effectiveness. Mention wasalso l1lade of the ease of application ofHHP (seven responses). Thelnainreasons for non-purchase focused onthe 1110dalities not being needed or theability of another l1lodality to producesilllilar effects. Two 111odalities, HHP

and WE, were identified as being"messy" to apply (two and threeresponses respectively). Safetyconcerns accounted for a very smaIlnumber of negative responses for anyof the superficial heat modalities (totalof five responses). This contrasts with atotal of 17 responses expressing thesame concerns about SWD andMWD.

OthersMagnetic field (MF), pressure pump,

biofeedback and laser could be seen asthe less traditional modalities availableto physiotherapists. Ultra....violet (UV)lamps, on the otherhand,havebeenavailable for some time but theirtherapeutic use has been limited to

. specific skin conditions (WadsworthandChanmugan 1983).

As shown in Table I,MF wasavailable in more clinics (36 percent)and used more often (69 per cent ofclinics owning a unit used it at leastonce per day) than any of the othermodalities listed in this section.Effectiveness was the main reasonlisted by respondents for using MF"Frequently" (12 responses). Ease ofapplication (four responses) and safety(two responses) were also mentioned.Reasons for not purchasing MFincluded questionable research and/orclinical results after a trial period (18responses) and cost factors (fourresponses)4 Based on the distribution ofusage frequencies (Table 1) it appearsthat MF is another modality which, ifowned, tended to he used often.

Pressure pump and biofeedback,while completely different in their

AUSTRAliAN PHYSIOTHERAPY ORIGINAL ARTICLE

applications, were very similar in termsof their ownership and usagefrequencies. Effectiveness was, onceagain, the main reason given byrespondents for using either of thesemodalities "Frequently". Practitionersnot owning one of these units gavereasons such as "modality not needed","intend to purchase" or "unfamiliarwith the modality" to explain theircurrent position.

Laser units are one of the morerecent electromodalities available tophysiotherapists, with the firstcommercially-available unit appearingin Europe in the early 1970s (Castel1985). It is possible that laser'srelatively short history may explainwhy only 16.5 per cent of clinics had aunit available for use. Table 3 showsthat most respondents gave

questionable effects and unfamiliarityas reasons for not purchasing laser.

As previously mentioned, UV haslimited clinical applications. This mayexplain why only 10 per cent of privatepractices surveyed used one of theseunits. This viewpoint was supported bythe comments listed in Table 3 whichshowed that most respondents felt thatUV was not sufficiently required towarrant purchasing (30 responses).The fact that Brisbane is recognized ashaving a sub-tropical environmentwith abundance of natural UV mayalso have contributed to the low usageofUV.

Although not one of the mainpurposes of the study, special clinicalinterests were also investigated by theauthors. While 33 per cent of

respondents did not indicate anyparticular clinical interest, 20 per centlisted sports physiotherapy and afurther 18 per cent listed manipulativephysiotherapy. It is possible thatpractitioners' background trainingcould have reflected these specificinterests. The majority ofpractitioners surveyed in this study(77.5 per cent) trained at theUniversity of Queensland. This factorcould influence not only the types ofspecial interests practised, but also therespective electromodality ownershipand usage frequencies established inthis survey. Clearly additionalresearch, particularly in other nationalor international centres, is indicated tofurther investigate the trends identifiedhere.

From Page 255

ConclusionsElectromodality ownership and usage

frequencies within Brisbane's privatepractices were shown to be non­uniform. It would appear that theapparent lack of objective scientificreporting on the treatment effects ofelectrotherapeutic agents has notprevented clinicians from formulatingtheir own opinions. Two modalities,US and IF, received particularly strongsupport from clinicians in terms ofperceived effectiveness. Whileeffectiveness was consistently listed asthe main reason for using any modality"Frequently", other factors, such assafety and ease of application, werealso often mentioned. Commonreasons for not purchasing a modalityincluded perceptions that it was notneeded, the ability to use anothermodality for similar effects, cost, lackoffamiliarity, and safety concerns.Overall, it appears that cost-­effectiveness plays an important role inmodality ownership.The majority of respondents (77.5

percent) trained at.the University ofQueensland" Any extrapolation ofthefindings ofthis study must take thisfact into consideration. It is hopedthat further research in other nationaland.international centres may providefor future comparisons.

Acknowledgements:The authors wish to acknowledge the

assistance ofthe University ofQueensland PhysiotherapyDepartment and The University ofCalgary SportMedicine Centre in thepreparation of this manuscript.

ReferencesCastelMF(1985): A Clinical Guide to Low Power

Laser Therapy, Physio Technology Ltd,Downsview.

DelpizzoVand]oyner KH (1987): On the safe useofmicrowave andshortwave diathermyunits.AustralianJournalofPhysiotherapy33 :152-162.

Dennis JK (1987a): Decisions made byphysiotherapists: A study of privatepractitioners inVictoria. AustralianJournalof·Physiotherapy 33:181-191.

Dennis]K(1987b): VVhatphysiotherapists inprivatepractice do: The effects ofsex and training onclinical behaviour. Australian Journal ofPhysiotherapy 33:245-252.

DHW (1980a): Canada...;wide Survey of Non­ionizing Radiation EmittingMedical Devices,Part I: Short Wave and Microwave. Devices.Canadian· Dept of Health and Welfare, 80­EHD-52.

DHW (1980b):Canada...;wide Survey of Non­ionizingRadiation EmittingMedical Devices,Part II: Ultrasound Devices. Canadian Deptof Health and Welfare, 80-EHD-53

GanneJM (1976): Interferential therapy. AustralianJournal ofPhysiotherapy 22:101-110..

IdeL (1990): Recent developments inelectrotherapy.Physiotherapy 76: 7-8.

Kloth L (1986): Shortwave and MicrowaveDiathermy. In Michlovitz SL: ThermalAgents in Rehabilitation. Philadelphia: FADavis Co.

McDiarmidT and Burns PN (1987): Clinicalapplications of therapeutic ultrasound.Physiotherapy 73:155-162.

NelsonB (1981): Interferential therapy. AustralianJournal ofPhysiotherapy 27:53-56.

Paxton SL (1980): Clinical uses ofTENS. PhysicalTherapy 60:38-43.

Robinson AJ and Snyder-Mackler L (1986): Extentof clinical use of eight common types ofelectrotherapy (Abstract). Physical Therapy66:774.

RobinsonAJand Snyder~MacklerL(1988): Clinicalapplication of e1ectrotherapeutic modalities.Physical Therapy 68:1235-1238.

AUSTRAliAN PHYS10THERAry

RothsteinAL (1985): Research DesignanclStatisticsfor Physical Education. Englewood Cliffs:Prentice-RallInc.

Shealy eN (1973): Transcutaneouselectroanalgesia. SU1wcai Forum 23:419.

Ter Haar G, Dyson M and Oakley S (1988):Ultrasound in physiotherapy in the UnitedKingdom: Results of a questionnaire.Physiotherapy Practice 4:69-72.

Thomas CL (Ed) (1983): Taber's CyclopedicMedical Dictionary. Philadelphia:FA DavisCo, p 461.

Wadsworth H andChanmugam APP (1988):ElectrophysicalAgents in Physiotherapy,2ndEdition. Marrickville: Science Press.

ZizkinMCand Michlovitz SL(1986): TherapeuticUltrasound~In Michlovitz SL (Ed): ThermalAgents in Rehabilitation. Philadelphia: FADavis Co.