Physical Agent Modalities in Early Osteoarthritis: A Scoping Review

Abstract: Early osteoarthritis (EOA) still represents a challenge for clinicians. Although there is no consensus on its definition and diagnosis, a prompt therapeutic intervention in the early stages can have a significant impact on function and quality of life. Exercise remains a core treatment for EOA; however, several physical modalities are commonly used in this population. The purpose of this paper is to investigate the role of physical agents in the treatment of EOA. A technical expert panel (TEP) of 8 medical specialists with expertise in physical agent modalities and musculoskeletal conditions performed the review following the PRISMA‐ScR (Preferred Reporting Items for Systematic Reviews and Meta‐ Analyses Extension for Scoping Reviews) model. The TEP searched for evidence of the following physical modalities in the management of EOA: “Electric Stimulation Therapy”, “Pulsed Electromagnetic field”, “Low‐Level Light Therapy”, “Laser Therapy”, “Magnetic Field Therapy”, “Extracorporeal Shockwave Therapy”, “Hyperthermia, Induced”, “Cryotherapy”, “Vibration therapy”, “Whole Body Vibration”, “Physical Therapy Modalities”. We found preclinical and clinical data on transcutaneous electrical nerve stimulation (TENS), extracorporeal shockwave therapy (ESWT), lowintensity pulsed ultrasound (LIPUS), pulsed electromagnetic fields stimulation (PEMF), and whole‐body vibration (WBV) for the treatment of knee EOA. We found two clinical studies about TENS and PEMF and six preclinical studies—three about ESWT, one about WBV, one about PEMF, and one about LIPUS. The preclinical studies demonstrated several biological effects on EOA of physical modalities, suggesting potential disease‐modifying effects. However, this role should be better investigated in further clinical studies, considering the limited data on the use of these interventions for EOA patients

Physical Agent Modalities in Early Osteoarthritis: A Scoping Review

Early osteoarthritis (EOA) still represents a challenge for clinicians. Although there is no consensus on its definition and diagnosis, a prompt therapeutic intervention in the early stages can have a significant impact on function and quality of life. Exercise remains a core treatment for EOA; however, several physical modalities are commonly used in this population. The purpose of this paper is to investigate the role of physical agents in the treatment of EOA. A technical expert panel (TEP) of 8 medical specialists with expertise in physical agent modalities and musculoskeletal conditions performed the review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) model. The TEP searched for evidence of the following physical modalities in the management of EOA: “Electric Stimulation Therapy”, “Pulsed Electromagnetic field”, “Low-Level Light Therapy”, “Laser Therapy”, “Magnetic Field Therapy”, “Extracorporeal Shockwave Therapy”, “Hyperthermia, Induced”, “Cryotherapy”, “Vibration therapy”, “Whole Body Vibration”, “Physical Therapy Modalities”. We found preclinical and clinical data on transcutaneous electrical nerve stimulation (TENS), extracorporeal shockwave therapy (ESWT), low-intensity pulsed ultrasound (LIPUS), pulsed electromagnetic fields stimulation (PEMF), and whole-body vibration (WBV) for the treatment of knee EOA. We found two clinical studies about TENS and PEMF and six preclinical studies—three about ESWT, one about WBV, one about PEMF, and one about LIPUS. The preclinical studies demonstrated several biological effects on EOA of physical modalities, suggesting potential disease-modifying effects. However, this role should be better investigated in further clinical studies, considering the limited data on the use of these interventions for EOA patients

Physical Modalities in the Management of Wound(s)

Wound is caused by disruption of the integrity of body skin as a result of environmental or medical factors. Managing chronic and refractory wounds is a significant dilemma physicians are facing. Large varieties of treatment modalities have been used to enhance wound healing among which were different medicines, surgical procedures, physical therapy, hyperbaric oxygen therapy, and physical modalities such as laser and shockwave. In this chapter, the authors discuss physical modalities that are most used in the management of wound healing with a focus on lasers, shockwaves, photodynamic therapy, UVB therapy, and lights and describe some important experimental and clinical trials that have been done in this regard with an attempt to explain their mechanisms

A Survey of the Use of Physical Agents and Therapeutic Modalities in Physical Therapy

Background and Purpose. It is desirable that physical therapy programs update their curricula according to the clinical application patterns of physical agents and therapeutic modalities in physical therapy. The purpose of this study is to 1) determine the frequency of use of physical agents and therapeutic modalities, 2) determine the factors in deciding which physical agent or therapeutic modality to use, 3) determine the educational coverage of each physical agent or therapeutic modality and identify strengths and weaknesses of the respondents training, and 4) compare the frequency of use with the current training in physical agents and therapeutic modalities at the University of North Dakota\u27s physical therapy program (UND-PT). Subjects and Methods. A survey was sent to 690 physical therapists at 230 clinical sites in the United States affiliated with the UNO-PT. It consisted of seven sections: thermomodalities, electromodalities, mechanical agents, hydromodalities, educational coverage, open-ended questions, and demographic information. The data were analyzed and the results are depicted within this study. Results. The three most frequently used physical agents or therapeutic modalities were cold packs (x = 19 ± 23 times/week), ultrasound (x = 17 ± 23 times/week), and hot packs (x = 15 ± 23 times/week). Primary practice setting influenced the choice of the three most used modalities, with a markedly greater use of physical agents and therapeutic modalities in the outpatient orthopedics and sports medicine settings. The three most important factors in deciding which physical agent or therapeutic modality to use were the purpose/availability/ease of application of the physical agent or therapeutic modality (18%), patient signs and symptoms (16%), and effectiveness (15%). The three most frequent strengths of the respondents\u27 educational coverage were the amount of lab time spent practicing to use the modalities (32%), depth of coverage (22%), and variety of coverage (20%). The four most frequently perceived limitations of educational coverage were practice time (25%), depth of coverage for the entire course (13%), equipment concerns (13%), and a limited emphasis on research (13%). We consider the coverage of physical agents and therapeutic modalities at UND-PT to be consistent with the results of our survey. Discussion and Conclusion. A sparse amount of research on this topic exists, limiting comparisons between studies, which could account for many differences. These differences existed in geographical regions, time span between studies, and the narrow scope of clinical settings and modalities studied. Currently, reimbursement issues, evidence-based practice, and clinical effectiveness influence the frequency of use of physical agents and therapeutic modalities. Further research is needed on the use of physical agents and therapeutic modalities across practice settings and clinical experience. Further research can also be studied on a broader population base

A Review of Physical Therapy Intervention in the Healing of Wounds

Treatment of chronic wounds, such as pressure ulcers or arterial-insufficient ulcers, are commonly seen in health care today. Wound treatment is advancing and physical therapists are using modalities in the intervention to hasten wound healing. Electrical stimulation and ultrasound have been established through clinical studies as effective modalities for the treatment of wound healing. The purpose of this paper is to review and analyze current literature about physical therapy and wound care. This paper will discuss an overview of the anatomy of skin, physiology of wound healing, documentation of wounds, and physical therapy intervention with emphasis on electrical stimulation and ultrasound

Efficacy and Effectiveness of Physical Agent Modalities in Complex Regional Pain Syndrome Type I: A Scoping Review

Complex regional pain syndrome type I (CRPS-I) is a rare condition with huge variability in triggering factors and clinical scenarios. The complexity of the pathophysiology of this condition fosters the proposal of several therapeutic options with different mechanisms of action in both research and clinical practice. An interdisciplinary and multimodal approach, including pharmacological and non-pharmacological interventions, particularly physical therapy, is recommended by international guidelines, but the benefits and harms of available interventions are poorly known. In this scoping review, the clinical rationale for use of physical agent modalities for patients with CRPS-I will be presented. We found 10 studies addressing the role of electromagnetic field therapy, electrotherapy, and laser therapy. Our findings suggest that physical therapy modalities, in particular transcutaneous electrical nerve stimulation (TENS) and pulsed electromagnetic field therapy (PEMF), may contribute to reduce pain and improve function in patients with CRPS-1

ROS Pleiotropy in Melanoma and Local Therapy with Physical Modalities

Metabolic energy production naturally generates unwanted products such as reactive oxygen species (ROS), causing oxidative damage. Oxidative damage has been linked to several pathologies, including diabetes, premature aging, neurodegenerative diseases, and cancer. ROS were therefore originally anticipated as an imperative evil, a product of an imperfect system. More recently, however, the role of ROS in signaling and tumor treatment is increasingly acknowledged. This review addresses the main types, sources, and pathways of ROS in melanoma by linking their pleiotropic roles in antioxidant and oxidant regulation, hypoxia, metabolism, and cell death. In addition, the implications of ROS in various physical therapy modalities targeting melanoma, such as radiotherapy, electrochemotherapy, hyperthermia, photodynamic therapy, and medical gas plasma, are also discussed. By including ROS in the main picture of melanoma skin cancer and as an integral part of cancer therapies, a greater understanding of melanoma cell biology is presented, which ultimately may elucidate additional clues on targeting therapy resistance of this most deadly form of skin cancer

Competencies and physical agent modalities: An investigation of clinical and ethical implications

Occupational therapy has evolved from its early inception in diversional therapy to incorporate technologically advanced modalities into the professional domain. Over the last thirty years the profession has increasingly incorporated physical agent modalities (PAMs) into the treatment process. Throughout this process there has been both opposition and support for the inclusion of PAMs in occupational therapy. There are concerns from both sides regarding the proper training of therapists in the use of PAMs, how competency should be assessed, who is responsible for ensuring competency, and the ethical concerns with the use of these modalities. This phenomenological study analyzed six therapists’ views on competency testing and the clinical and ethical implications involved in the use of PAMs. The findings of this study are compared and contrasted to the core ethical principles of occupational therapy. These include principles of beneficence, nonmaleficence, autonomy, confidentiality, duty, procedural justice, veracity, and fidelity

The Safety and Efficacy of Physical Agents on Cancer Survivors: An Update

Title: The Safety and Efficacy of Physical Agents on Cancer Survivors: An Update Authors: Gentry Ensign, SPT1; Kathryn Flyte, SPT1; Michael Moore, SPT1; Katelyn Ratliff, SPT1; Ann Wilson, P.T., M.Ed., GCS1 Affiliations: 1. School of Physical Therapy, University of Puget Sound Theory: Cancer patients are often referred to physical therapy to treat impairments associated with cancer, its treatment, and the disease progression. Physical therapists sometimes use physical agents as part of a complete rehabilitation program for the purpose of decreasing pain, increasing strength, and facilitating tissue healing while avoiding possible malignant tumor growth. The benefits of physical therapy modalities in cancer treatment has not been well defined, but have potential to improve quality of life, functional abilities, and participation for these patients. Currently, many physical agents are contraindicated in the treatment of cancer patients because of potential concerns that they may increase the growth or rate of growth of malignant tumors. The lack of clinically-applicable and high-quality studies that support or refute these theories makes the use of some physical therapy modalities in the treatment of cancer patients controversial. For this reason and due to the changes in contemporary modality use over the last fifteen years, an update of the current literature is warranted. The purpose of this literature review is to update an already-existing literature review by Pfalzer in 2001 discussing the use of modalities in treatment of cancer-related impairments. References: Kozanoglu E, Basaran S, Paydas S, Sarpel T. Efficacy of pneumatic compression and low-level laser therapy in the treatment of postmastectomy lymphoedema: A randomized controlled trial. Clin Rehabil. 2009;23(2):117-124. Hurlow A, Bennet MI, Robb KA, Johnson MI, Simpson KH, Oxberry SG, Transcutaneous electric nerve stimulation (TENS) for cancer pain in adults. Cochrane Database of Systematic Reviews. 2012; 3: 1-26. Cheville AL, Basford JR. Role of Rehabilitation Medicine and Physical Agents in the Treatment of Cancer-Associated Pain. J Clin Oncol. 2014;32(16):1691-1702. Majithia N, Smith TJ, Coyne PJ, et al. Scrambler Therapy for the management of chronic pain. Support Care Cancer. 2016;24:2807-2814

Lowering Depression Symptoms in Adults: Exploring Nonpharmacologic/Non-talk Therapy Based Approaches

Background: Depression has a high prevalence, affecting more than 300 million people worldwide.1 Antidepressants and talk therapy are the current mainstays for treatment. Given the high prevalence of depression, there is value in the research regarding further treatment options. Purpose: A literature review of studies exploring additional treatment modalities to lower depression symptoms in adults. Methods: A comprehensive literature review was conducted using with the search terms \u3c(adults) AND (depression, low mood, mental health) AND (pharmacologic, SSRI, SNRI) OR ( physical activity, fitness, exercise), OR (time outdoors, UV exposure, phototherapy) OR (non-talk therapy)\u3e. Inclusion criteria were studies that were published from 2015 to the present. Exclusion criteria were studies not in English. Conclusions: Aside from the currently recommended approaches to treating depression, pharmacologic and talk-therapy, other treatment modalities were explored in this literature review. Such treatment modalities include exercise, time outdoors, and alternative therapies. These treatment modalities yielded similar results to the current recommendations in decreasing symptoms of depression