PT Voodoo

Voodoo God of Wealth

The New York Times has a good article about voodoo in PT – the use of modalities that have no clinical research evidence behind them (not that medicine doesn’t have it’s own problems…). The article is one-sided in only interviewing physicians and not PT’s or even the APTA, and I hope to see either the APTA or the Orthopaedics Section respond to it. The article does have good points however – as PT’s we should be able to give theoretical and evidenced reasons for what we do, as well as how long it should take (while acknowledging every patient is different).

Beyond cryotherapy (use of cold) for short-term pain relief for patients in the initial phase after a total knee replacement after a PT session, I have not found an instance or any research to support the use of modalities for any of the clients I have seen or am seeing (keeping in mind I’m a new grad). While there may be a theoretical basis for modalities, there is either evidence against it (as effective as a sham treatment), evidence showing as effective as stretching/ strengthening, or a paucity of evidence.  We need to know not just the theoretical basis of modalities but also the evidence, then choose appropriately.

Photo: Voodoo God of Wealth, originally uploaded by rosscrawford1

Addendum 1/11: Thanks to Mike Reinold – it turns out that Dr. Irrgand is a PT and that the article misquoted and twisted his words (I missed that he is president of the Ortho section, and thought a PT would have been a better defender of the profession and evidence for it, not expecting to have a bad representation of the interview).  I appreciated Mike’s “take home” comments as well (I’m not against modalities, just very cautious, and don’t consider myself an extreme EBP person but I do look for evidence in the literature; I’m willing to use it if there is a lack of evidence currently but not if it is as effective as sham or effective as something else I can do).

Addendum 1/14: The APTA has a blog post about the article and includes a lengthy response from Dr. Irrgand in the comments section.  Check it out.

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