Clinical Electrotherapy, ed 3.

Nelson RM, Hayes KW, Currier DP, eds. Stamford, CT 06912, Appleton & Lange, 1999, hardcover, 578 pp, $49.95.

This book is the third edition of a popular electrotherapy textbook. Although it is designed as a textbook for professional physical therapist students, it would be valuable for the practicing physical therapist who wants a refresher on clinical electrophysiology and electrotherapy. This edition has been extensively revised to reflect the Guide to Physical Therapist Practice, Electrotherapeutic Terminology in Physical Therapy, and the World Health Organization disablement model.

The first section of the book contains chapters on basic electrophysics, equipment safety, electrophysiology, and electrotherapeutic terminology. A discrepancy still exists between the terminology for electrical currents used in the APTA's Electrotherapeutic Terminology in Physical Therapy and the terminology commonly used by manufacturers, and students are often confused by this difference. This book should be praised for its solution to this terminology problem. Gad Alon, author of the chapter on terminology, begins this chapter with the electrical current terms used in Electrotherapeutic Terminology in Physical Therapy. The chapter then discusses electrical stimulators using the terms commonly used by manufacturers. A table then compares the 2 sets of terms. This appears to be a very effective way of dealing with the terminology problem and should minimize the reader's confusion.

The second section of the book focuses on the clinical application of electrotherapy with chapters on electrical stimulation for improving muscle performance, speeding tissue repair, decreasing pain, increasing functional activity, and stimulating denervated muscles. Each chapter has a case study that illustrates the application of electrical stimulation. The chapters on tissue repair and stimulation of denervated muscle have clearly defined protocols toward the end of each chapter. The other chapters in this section of the book could also have benefited from such clearly defined protocols. One could argue that giving these protocols could lead to cookbook electrotherapy by the student or therapist; however, protocols for electrical stimulation can give the student and therapist a place to start in setting up and providing electrotherapy treatment. Any electrotherapy text should provide the variables that can be modified in order to produce optimal outcomes. This text outlines these variables in each chapter. For example, the chapter on transcutaneous electrical nerve stimulation discusses issues such as optimal electrode placement and frequency and pulse-duration settings and amplitudes.

Chapters on stimulating denervated muscle, functional electrical stimulation, stimulation for wound repair, and stimulation for muscle strengthening have clearly defined outcomes, which can be documented. However, only the chapters on stimulation for wound repair and stimulation for muscle strengthening have clear statements on how the clinical documentation should be done. None of the chapters discuss issues related to reimbursement of electrotherapeutic modalities or even the current trends in reimbursement. Reimbursement is an increasingly important part of the new graduate's clinical practice.

The third section of the book is entitled "Contemporary Application of Electrotherapeutic Examination and Intervention." This section includes chapters on the evaluation of new electrotherapy treatments, the uses of biofeedback, and an overview of electrophysiologic evaluation. The chapters on biofeedback and electrotherapeutic evaluation are very elementary and, unlike the chapters on electrical stimulation, do not provide the needed foundation for the use of this intervention and these evaluation techniques.

The chapter on the evaluation of new electrotherapy treatments, however, should be singled out for the highest praise. This chapter is based the approach first described by Susan Harris in her 1996 article in Physical Therapy (Harris SR. How should treatments be critiqued for scientific merit? Phys Ther. 1996;76:175-181), and the chapter outlines 5 criteria that should be used in judging all treatments. These criteria are: (1) "The theory supporting the approach is logically sound and supported by valid anatomic and physiologic evidence"; (2) "The treatment approach is designed for specific impairments or functional limitations based on etiology"; (3) "Potential side effects of the treatment are presented"; (4) "Studies from peer-reviewed journals are provided that support the treatment's efficacy. These studies include well-designed, randomized, controlled clinical trials or well-designed single-subject experimental studies"; and (5) "The proponents of the treatment are open and willing to discuss the approach's methods, benefits, and limitations." These criteria form the basis for evidence-based practice in physical therapy, and all textbook authors should use these standards to judge the treatments that they endorse. The chapters in section 2 of this book use this basic approach in describing the application of electrotherapy.

Overall, this book provides an effective summary of electrotherapeutic approaches in physical therapy. It is a useful resource for both the practicing clinician and the physical therapist student.

David A Lake, PhD, PT Armstrong Atlantic State University Savannah, Ga

Dr Lake is Professor and Department Head of the Department of Physical Therapy where he teaches research design, cardiopulmonary physical therapy, and exercise and physical agents. His research interests are exercise, physical agents, and educational innovations.