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Re: Laser Therapy - A John Barnes Link?
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Re: Laser Therapy - A John Barnes Link? - December 6, 2005 11:23:00 AM
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drbuddy
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If there is something that can help enhance healing and/or decrease pain, why not use it?
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Re: Laser Therapy - A John Barnes Link? - December 6, 2005 2:12:00 PM
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JLS_PT_OCS
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Well, it seems to me, from reading the actual research reports, that the main problem is a variance in the type of device, wavelength, power output, and a host of other variables. If you get into the science of lasers (and I'm no physicist, believe me) it really is interesting how many ways there are are to produce directed light.
The primary issue now appears to be that there are SO MANY different ones out there, and so many studies of poor quality or of incompatible designs, that you just don't get a chance to build a good case for a certain set of parameters and really do a good study. Just one good placebo controlled RCT with reproducible parameters would be a start. But the ones that are out there have confounding variables, and unclear methods, published in journals not indexed on medline, etc etc.
Well I'm with Buddy in that it is possibly a useful modality. I don't see the harm in using an adjunctive therapy if it has some science and a plausible theory behind it. But the laser companies are really going to have to get their ducks in a row and produce some better research before a lot of us EBP types will jump on this train.
If this DVD is indicative of the kind and quality of "marketing" going on in the laser world, then those of us who are essentially dismissive of hokey "alternative" modes of care will never get on board.
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Laser Therapy - A John Barnes Link? - December 6, 2005 2:46:00 PM
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SJBird55
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David and all... there comes a time when we as professionals need to be held accountable for our clinical decision-making process - it is here and now. If we are going to be "autonomous," then there's an additional professional responsibility of requiring accountability of our peers.
It's about darn time we all start pushing the issue when we see crap. And of course, whomever is questioned is going to probably be put on the defensive and probably won't be comfortable with the questioning of others and probably will see it as a personal attack because questioning one's authority or one's theory or one's practices actually is kind of personal. I didn't see a gun pointed at Kleinkort's head. For someone in his position and with the path the APTA and others are working diligently on/toward, frankly, Kleinkort isn't setting an example of who we should emulate. He didn't have the courage to argue his view or educate anyone at Evidence in Motion and he isn't taking the time to do it here. That to me speaks volumes... I doubt that he has any logical explanation or a strong capability to debate with facts to enlighten those of us with questions (and he knows it). I really think that the days in our profession and within our profession of just accepting what a therapist says is just easily accepted are over. Times are a changing.
Also, the days of making decisions solely based on "do no harm" are coming to an end... combine "do no harm" with "efficient and effective" and that's the optimal standard we should be meeting.
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Re: Laser Therapy - A John Barnes Link? - December 6, 2005 2:52:00 PM
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Jon Newman
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Jason,
You should consider a subscription to [URL=http://www.sram.org/]The Scientific Review of Alternative Medicine and Aberrant Medical Practices[/URL] (SRAM) based on your predilections.
In the Fall/Winter 2004-2005 issue they had an interesting editorial that shed light on why the SRAM was not indexed on medline/pubmed. It was quite enlightening and may change your mind about the quality of journals that are and are not indexed. Skepticism is hard work indeed.
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Laser Therapy - A John Barnes Link? - December 7, 2005 4:12:00 AM
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JLS_PT_OCS
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Jon-
I'll check that out, thanks for the recommendation. I would think, given your posts and our history of discussions, that your recommendation of it is stronger than Medline's decision to accept or reject it.
While I don't think Medline is a perfect example of quality in journals, I think there needs to be some sort of quality standard by which we can begin to judge things, and for what it's worth, that's one such standard. I should caveat that with the statement that I saw the full text of most of the supporting articles, and they were not of very good quality, regardless of the journal they were in.
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Laser Therapy - A John Barnes Link? - December 7, 2005 4:23:00 AM
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FLAOrthoPT
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there is, it is called PEDro and it is called hooked on evidence, they are PT peer reviewed articles, anyone can submit a review, and it is then reviewed, check them out
hookedonevidence.com
and type PEDro in google, it is there
great EBM sites:
Ben
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Re: Laser Therapy - A John Barnes Link? - December 7, 2005 4:26:00 AM
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drbuddy
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If anyone is truly interested in laser therapy, try to rent or ask for a trial period. Then, you can use it for yourself and decide whether or not the results are worth the cost.
Some companies will let you try it for free, but most charge around $400 per month, that would then be deducted from the sale price if you decide to buy.
Then again, you could wait for high quality research. I'll take care of people in the meantime : )
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Re: Laser Therapy - A John Barnes Link? - December 7, 2005 4:52:00 AM
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JLS_PT_OCS
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A side note is that Erchonia, at least in this situation, will not lease the unit, and insists that it be purchased. Another red flag.
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Laser Therapy - A John Barnes Link? - December 7, 2005 6:55:00 AM
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Jeep
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Jon-
I think there are many valid reasons why SRAM has not been indexed. Look a little deeper- W. Sampson, author of the editorial you reference, is on the board of advisors of NCAHF, and NCCAMwatch(quackwatch). Who has the REAL political agenda? IMO, they were very prudent in not accepting this so called "journal" for indexing, and KUDOS to Mr. Kotzin for being so very astute.
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Re: Laser Therapy - A John Barnes Link? - December 7, 2005 7:06:00 AM
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Shill
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If you can defend your use of modalities based on what research exists for it, there is no problem with the judicious use of modalities. If you have literature that refutes use of said modality for a specific diagnosis, then you should not use it. Does it need to be more difficult than this?
I should add that when there is no literature for support or dismissal, and other treatments have not been shown to help, it is reasonable to try a modality, again provided you have a plausible theory for doing it.
This is how great things have been discovered, no?
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Steve Hill PT
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Re: Laser Therapy - A John Barnes Link? - December 7, 2005 7:47:00 AM
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Jon Newman
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Hi Jeep,
I don't see what is inherently wrong or even political with NCAHF or quackwatch. Since you have looked deeper into this what are their politics?
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Re: Laser Therapy - A John Barnes Link? - December 7, 2005 7:49:00 AM
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JLS_PT_OCS
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Exactly, Steve.
However, my argument is presented based on an implausible rationale of a high cost device with mixed research support for which a practitioner appears to be intimately involved with the manufacturer. And a rationale which is the exact same, if not so very close, to other treatment paradigms which are generally accepted to be refuted (craniosacral, Myofascial Release a la John Barnes).
Jeep-
Membership on those boards of advisors I don't think is an open and shut case against SRAM. Certainly there are prominent medical researchers at NIH and other government-sponsored institutions studying CAM whose very job and livelihood DEPENDS on some positive results from the treatments they are studying. There is bias on both sides of every issue, and this is even noted by Assendelft et al in JAMA in the reviews of manipulative therapy, noting that there was more likely to be a positive review if a manipulator (PT, DC, DO) was among the reviewers.
But at least Medline has drawn a line in the sand so to speak, and whether it should be moved this way or that a few feet is more a question of opinion and perspective than fact. Certainly NCCAMwatch and NCAHF have given you guys (DCs) a bit of a hard time (for, I think we'll agree, many of the right reasons) and I don't blame you for being careful about SRAM. Many skeptics sometimes forget that skepticism is an approach, (not a position) and their activism at times can be overzealous toward new or evolving treatments. I haven't read enough of the journal to be sure, but I think, were their energies directed towards modern physical therapy practice, that they would find a bit to quarrell with as well. Starting with modalities. :)
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Laser Therapy - A John Barnes Link? - December 7, 2005 7:53:00 AM
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nari
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Interesting debate on the ongoing issue of modalities or not....which seems to raise hackles in the defenders of modalities.
pedRO is a good resource for checking out the usefulness of something, but watch the scores - many reviews are low in scores...
To a patient, walking into a room full of shiny machines that look like this PT really knows what works, the effects are truly impressive. Patients want gizmos which will fix them up in a short space of time; and which mean they don't have to do anything themselves. That is an extreme example, I know, because few PTs would use only machines; but I am with Ben on this one. Particularly when PT is referred in many cases (and this appears in studies)as 'modalities' and little else. If we are known for being passive modality deliverers, whether it is an accurate portrayal or not,well.....that bothers me no end.
Why spend money, when hands and voice can be more reliable with longer lasting results?
Nari
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Re: Laser Therapy - A John Barnes Link? - December 7, 2005 8:08:00 AM
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Jeep
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Jason and Jon:
>>>Many skeptics sometimes forget that skepticism is an approach, (not a position) <<<
I think you capsulize it very well. Nachf and NCCAMwatch/quackwatch, of which this publication is intimately allied with, have a "position" they are promoting, This is why their "journal" was rejected. Mr. Kotzin is to be commended in his recognition of this.
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Re: Laser Therapy - A John Barnes Link? - December 7, 2005 8:31:00 AM
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Jon Newman
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Jeep,
I think that is the nature of my question. What is the position they are promoting?
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Re: Laser Therapy - A John Barnes Link? - December 7, 2005 8:01:00 PM
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goodlooks58
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I wonder if Erchonia and other LLLT machines are hocus pocus as there is little evidence to prove it's usefulness, then why do these companies go through great lengths to manufacture them and go through the hassle of selling them? Do they have stock holders questioning their products? A few years ago there was one compnay making a Laser like device but now thre are hundreds.
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Re: Laser Therapy - A John Barnes Link? - December 7, 2005 9:30:00 PM
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Jeep
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Jon-
Is there anything in SRAM that is NOT promoting a position?
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Re: Laser Therapy - A John Barnes Link? - December 8, 2005 1:42:00 AM
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Jon Newman
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Maybe I'm not understanding your point. Of course each article ends up promoting a position. Like most articles in any journal, a conclusion is drawn based on the facts presented. I thought you were arguing something else. Still, I don't see why that would disqualify a journal to be indexed on pubmed.
Perhaps you are advocating the banning of a journal for its critical review of the claims of alternative medicines. That too is hardly a reason to disqualify indexing unless the rules state somewhere, "critical thinkers need not apply for indexing".
I will concede that I am not privy to all of the reasons why the journal is not indexed. You seemed to have a deeper view however. Do you have some insight on the decision?
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Laser Therapy - A John Barnes Link? - December 8, 2005 3:14:00 AM
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JLS_PT_OCS
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Goodlooks-
I believe the perspective of the company is to sell products and make money. Most companies have an interest in producing quality products. If we define quality by customer satisfaction, then Erchonia has succeeded if Dr Kleinkort is any indication.
I listen with interest to Jon and Jeep's conversation.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Laser Therapy - A John Barnes Link? - December 8, 2005 3:18:00 AM
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drbuddy
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Yeah, I'm not sure why that is, goodlooks. I'd say I can think of at least 10-15 producing an actual laser device. All of the others make some sort of SLD or LED, which is a little different. Those are usually geared at consumers for everything from scar reduction to acne treatments.
I think for the most part, many of these companies just jumped on the bandwagon without knowing much about laser therapy themselves. Since it was more difficult to have higher powered lasers pass through the FDA, I think they shot for the low side so they wouldnt run into any major problems. Initially, the only lasers approved were between 5 and 33 mW, but now we are seeing many above 500 mW and in the infrared range. That is still fairly low power, but it's a start. I've talked with foreign researchers using lasers for low back pain that are 5-10 W. At those powers they defocus the beam so it doesnt cause tissue heating.
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