Clinical Electrotherapy: Your Guide to Optimal Treatment.

Bjordal JM, Johnson MI, Couppe C. Kristiansand, Norway, Norwegian Academic Press, 2001, paperback, 178 pp, illus, ISBN: 82-7634-320-1, $32.77.

The stated purpose of this book was 2-fold: (1) to make electrophysical agents (EPAs) more understandable to students and clinicians by simplifying the often complex nature of biophysical action and (2) to form a sound scientific basis for the use of EPAs in clinical settings. The book is divided into 5 parts containing 15 chapters: part 1 is titled "History and Scientific Basis"; part 2, "Electrical Currents"; part 3, "Ultrasound Therapy"; part 4, "Laser Therapy"; and part 5, "Electromagnetic Therapy."

The book begins with a brief history and a discussion of the use of physical agents. The authors state that ultrasound is the most commonly used EPA. According to the authors, there is little scientific evidence to support such widespread use, especially as a modality for heating tissues. The authors contend that the most common diagnoses in which EPAs are prescribed are acute soft tissue injuries, tendinopathies, and osteoarthritis. Pain relief is the most common treatment goal when using electrical currents. One of the most interesting chapters deals with the evaluation of clinical effects of EPAs. The authors are quite opinionated in their view of research evaluations such as those used by the Cochrane Collaboration. The authors maintain that many of the EPA studies reviewed used ineffective dosage and faulty treatment procedures that contaminated the studies. The authors contend that comparisons between traditional drug studies and EPA studies are flawed because drug studies use established doses in their treatment regimens, whereas EPA studies usually do not have established, optimal dosages. Furthermore, evaluating EPA studies the way that drug studies are evaluated may "nullify the positive results of EPA by publishing non-significant results from trials with invalid doses and treatment procedures." Regardless of whether you agree with the authors, the chapter provides food for thought regarding the evidence basis for the use of EPAs.

Chapters 5 through 11 discuss the physiology of soft tissue injuries, tendinopathies, osteoarthritis, muscle injury, and pain. There is also a short discussion of goal setting. Although brief, these chapters are well written and contain basic information that is well referenced. The rest of the chapters in the book take a similar approach because the authors discuss the physical agents and then discuss what they call the "scientific part," the chapters that review the literature regarding efficacy studies on specific physical agents.

The discussion of electrical currents is very basic and provides very little in the way of waveforms, parameters, and application techniques. However, the scientific part provides a good overview of evidence that either supports or refutes the use of electrical currents in a variety of conditions. The authors contend that there is strong evidence that electrical currents can reduce pain and edema and increase local muscle blood flow. The authors discuss the rationale for the most effective stimulation parameters for each of the physiological effects.

The authors argue that ultrasound should not be used for thermal effects at all. They found no strong evidence to support the use of ultrasound and only weak evidence supporting the use of ultrasound for tendinopathies, soft tissue injuries, and wounds. The chapter on laser therapy provides a short overview of lasers, along with an excellent review of the literature regarding use and effectiveness. The authors cite evidence that provides strong support for the use of laser therapy with tendinopathies and osteoarthritis. The discussion of electromagnetic therapy (ie, microwave and shortwave) is very brief, and the authors contend that there is strong evidence to support the use of electromagnetic therapy with joint inflammation, providing that a high dose is used.

Overall, the book is very readable and interesting. At times it is difficult to separate the author's opinions from scientific facts. However, the authors make every effort to support their views with scientific evidence. The chapters include a number of figures and tables that help summarize the information and the literature. The reference list is current and complete.

I believe that this book would be appreciated more by practicing clinicians than by students. It contains little in the way of application techniques and would not be sufficient for physical therapist students or physical therapist assistant students to learn basic procedures for the application of physical agents. This book would be a good resource for a course in evidence-based practice regarding the use of physical agents, and an excellent reference for academic faculty who teach a course on physical agents. Whether or not the reader agrees with them, the authors do provide a stimulating and thought-provoking look at the use of electro-physical agents.

Thomas M Mohr, PT, PhD University of North Dakota Grand Forks, ND

Dr Mohr is Professor and Chairman of the Department of Physical Therapy. His teaching responsibilities are in neuroscience, physiology, biomechanics, and electrophysiology. His research interests are in electromyography, biomechanics, and electrotherapy.