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Re: Why???
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Re: Why??? - June 23, 2004 10:30:00 PM
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Bournephysio
Posts: 585
Joined: April 25, 2002
From: Calgary
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"ECSWT has been shown to be no better than sham as well, but maybe that study was defective as well."
Assuming thats true (I believe that there is conflicting evidence with ECSWT), an effective treatment (ultrasound) is cheaper than a non-effective treatment (ECSWT) that people are willing to spend a lot of money on. That point only helps my argument. If you are insinuating that the ultrasound experiment was defective, no one here has come up with a good argument as to why it was defective.
"The point is: "doing US" for calcification or spur or whatever else shows up on imaging is fairly old hat. That is treating a diagnosis, rather than asess for alternative reasons for pain."
There is absolutely nothing wrong with treating both the source of the pain (supraspinatus tendinopathy for example) AND the reason for the pain (poor scapular control for example. In fact in many instances it is probably essential to do both.
"I am quite surprised at the number of people whose XRs show spurs, calcifications and prolapsed discs and have no pain."
The quoted study can easily be read as "patients with shoulder pain who happen to have calcific deposits in their shoulders benefit from ultrasound" If the calcium deposits had nothing to do with the subjects pain it doesn't change the fact that ultrasound was beneficial.
"Also those who have had pain in the shoulder from a theoretically calcified deposit whose pain resolved completely with NON EPA methods."
I'm assuming that EPA is referring to evidence based practice. Some peoples shoulders also get better with no treatment. How do you know your method worked if you don't have any evidence?
"I think EPA has had its day," What do you suggest replacing it with? The day of evidence based practice is just starting. Get used to it.
"the bandwagon for it is starting to need scrapping....?" Yes evidence based practice is a bandwagon of its own. The way many people envision it has its flaws. It definately has its strengths and its uses just like the manual therapy bandwagon. Just because it has its flaws doesn't give you an excuse to ignore good science.
"Ultrasound (therapeutic) is used here mostly by students and old PTs who have not 'moved on' in updating. It has been shown in numerous studies to be ineffective or no better than stright placebo in most conditions except acute mastitis and very acute sprains."
You seem willing enough to accept evidence when it supports your views. Why aren't you willing to accept evidence that challenges them?
Steve: Thanks. I'll take a look when I have a chance. I may have to start using ultrasound with more people. British Medical Journal. These guys just can't find a good journal to publish in.
Doug
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Re: Why??? - June 24, 2004 1:46:00 AM
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nari
Posts: 1568
Joined: November 14, 2003
From: Australia
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Doug
Perhaps things operate differently in your part of the world. Machines are expensive, very expensive, and there are other ways of dealing with pain that are as effective and do not cost organisations huge sums.
Diagnostic ultrasound would be beneficial for a physio to use and arrive at a treatment plan. So I am not against machines per se.
Reliance on therapeutic EPA is,in my opinion, not a cost effective way of managing pain; too little evidence that they are of value.
But as I said, things are regarded differently in other countries - end of debate.
Nari
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Re: Why??? - June 24, 2004 10:45:00 AM
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mcap56
Posts: 619
Joined: October 26, 2002
From: New York, NY
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I agree that, aS far as I know, ECSWT has had mixed findings but was there was some evidence for use in calcific tendonitis. I have not come accross the above referenced article for U/S, I will have to look into it. I wonder if it factored into the philadelphia panel.
An odds ratio of over 7 (with a very broad confidence interval) and one that is so difference from the relative risk is a bit of a red flag. Also, they did not control for anything but size original lesion in their analysis. However, looks good to me. And, I am not in a position to argue with the NEJM.
mcap
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Re: Why??? - June 24, 2004 12:52:00 PM
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Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
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People debate validity of NEJM articles daily...I really would like to know, do the US parameters set up in the US article benefit anyone? Is this cost effective care? Does the small number of patients bother anyone? Does the daily treatment seem odd or realistic? Does the lack of long term benefit vs sham alarm anyone?
Or in contrast, what would you do to make the article have more clinical benefit (3xweek for 2 weeks...a more realistic time frame...5-10 minute treatments, a more realistic duration...US vs hot pack for same duration...US vs OTC ibuprofen/naprosyn...US vs CFM...cost analysis for all of the above vs relative rest). Just curious.
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
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