Complementary Therapies in Rehabilitation: Evidence for Efficacy in Therapy, Prevention, and Wellness, ed 2.

Complementary Therapies in Rehabilitation: Evidence for Efficacy in Therapy, Prevention, and Wellness, ed 2 Davis CM, ed. Thorofare, NJ 08086, Slack Inc, 2004, hardcover, 412 pp, illus, ISBN: 1-55642-581-3, $42.95.

The editor of Complementary Therapies in Rehabilitation, Carol Davis, has brought together a team of authors and has given them a difficult assignment: to make physical therapists aware of the main features of various "alternative" therapeutic regimens and to encourage scientific examination of the efficacy and rationale for these interventions. Although the book does not have a specific statement of purpose, one aim seems to he to encourage practitioners to reconsider some techniques labeled as "alternative" and, by applying rigorous analysis, make them "complementary" to traditional physical therapy care. The therapies included in this volume range from therapeutic massage, myofascial release, and craniosacral therapy to Qi Gong, distance healing, and low-energy lasers.

The book discusses a total of 18 therapeutic approaches that are organized into 4 sections. The first section explains the editor's view of "holistic health care." In her introduction titled "Energy Techniques as the Way of Returning Healing to Health Care," Davis calls for a reevaluation of the current "reductionist" system that she claims reduces every patient to ICD-9 and CPT codes and places economic values above patient values. She also attempts to draw a parallel between the relationship of complementary therapies to traditional care on the one hand and the relationship of quantum physics to Newtonian physics on the other. The 3 technique sections that follow are titled "Body Work," "Mind/Body Work," and "Energy" Work."

The contributors have varied backgrounds, including physical therapy, occupational therapy, massage therapy, psychology, physiology, and medicine. Academic qualifications of the contributors range from master's degrees to the terminal degrees of PhD and MD. Perhaps because of this diversity of backgrounds, the chapters, although generally clearly written, vary considerably in their scientific orientation. Of particular note are chapters, 3, 14, 16, and 19, which cover the topics of therapeutic massage, Reiki, magnets, and distance healing, respectively. These chapters appear to be presented with the most dispassionate, analytical orientation. In spite of the differences in orientation, however, each chapter generally does a good job of providing basic information about the technique or therapeutic approach it covers. Of particular note in this regard are chapters 6, 8, 10, 11 and 14, which cover complete decongestive therapy, t'ai chi, yoga, Alexander technique, and Reiki, respectively.

Most of the text is written to introduce the alternative techniques and approaches to clinicians who are unfamiliar with these complementary approaches to patient care. It must be acknowledged that many of these topics are somewhat complex and therefore difficult to explain and that not all the chapters provide a readily accessible overview of the primary features of the technique or approach. Chapter 15, covering Qi Gong, is perhaps the least satisfying in this respect.

Each chapter usually contains one or more case studies that provide additional insight into how the particular technique or intervention might be integrated into a physical therapy plan of care. Each chapter also addresses the research evidence related to the topic of interest. These reviews of evidence are perhaps the least consistent aspect of the text. In part, this inconsistency is due to the lack of rigorous evidence in some areas. Some contributors, however appear to have chosen to ignore research with a negative implication for their particular area. The chapter on craniosacral therapy does not substantively discuss the research evidence pointing to the lack of internal validity of the underlying concept of the craniosacral rhythm, nor does it cover he number of studies that do not show efficacy. Anyone interested in these issues should read the review paper by Hartman and Norton (Interexaminer reliability and cranial osteopathy. Scientific Review of Alternative Medicine. 2002; 6[1]:23-34).

In general, the text provides insight into a broad array of complementary therapies as promised. Although the chapters vary somewhat in their approach to dm material, anyone wishing a better understanding of the different approaches to healing and wellness will find a good deal of useful information packed between the covers.

Roy Bechtel, PT, PhD University of Maryland School of Medicine Baltimore, Md

Dr Bechtel is Assistant Professor in the Department of Physical Therapy and Rehabilitation Science. His research and clinical interests focus on the efficacy and mechanisms of manual therapy interventions for prevention and rehabilitation of pain of spinal origin.