Evidence-Based Guide to Therapeutic Physical Agents.

Belanger AY. Baltimore, MD 21201-2436, Lippincott Williams & Wilkins, 2002, paperback, 467 pp, illus, ISBN: 0-7817-2108-3, $34.95.

This evidence-based handbook provides necessary information regarding the safe and optimal application of some commonly used therapeutic physical agents in rehabilitation, physical therapy, and sports medicine. It will appeal to a wide audience, including clinicians, instructors, and students who apply physical agents. The content may also appeal to other health care groups such as third party payers and government regulatory agencies.

The book is written in a user-friendly outline format. Tables, illustrations, and boxes help the reader locate specific information easily and quickly. The book is divided into 6 parts, the first 5 parts contain 14 chapters on various electrotherapeutic modalities and various physical agents, including electrical stimulation, shortwave diathermy and laser, ultrasound, infrared radiation modalities, and hydrotherapy. Each chapter is presented in a similar sequence: a historical perspective; the biophysical characteristics of the modality; its physiological and therapeutic effects; consideration for application; dosimetry; indications; contraindications; dangers, precautions, and recommendations; therapeutic decision steps; and an excellent reference list. The 6 chapters of the sixth part provide some practical guidelines. Safety, maintenance, skin temperature and measurement, temperature ranges of thermal agents, and purchase considerations are included. In addition, an excellent illustrated glossary of electrotherapy terms is included to aid the reader. A quick reference guide to the physical agents is included in an appendix. This table outlines the main proposed therapeutic effects, energy delivered, coupling media, and the targeted tissue.

The numerous tables are a very helpful component of this book. Three informative tables--"Indications," "Contraindications," and "Dangers/Precautions/ Recommendations"--are consistently presented in the first 14 chapters. The indications table is based on peer-reviewed human studies. It lists the pathological conditions, whether the modality has been found to be beneficial, the "grade" of the research, and the reference to the published study. The studies are classified by grades I (human, controlled study), II (human, noncontrolled study), or III (case study). Animal studies are not included in this text. A reader can locate a modality, see if the pathological condition of interest has been researched, and determine the quality of the study, which aids their clinical decision making. Tables are also used to list contraindications and to list dangers, precautions, and recommendations, providing a quick concise source. The rationales for use of the modality and its contraindications are included and referenced.

Besides tables, the author uses boxes and step-boxes for quick review of information such as the physiological effects of a modality and dosimetry. Each physical agent has a step-box summarizing the decision-making process for the safe and ethical application of the modality. The author enhances the text even more with numerous three-dimensional illustrations of the currents and energy waveforms.

In summary, this book begins to bridge the gap between knowledge based on experience and knowledge based on evidence. The information is easily accessible and will help the busy clinician as well as enhance the body of information that students can use to make decisions. Although some modalities and their applications are well referenced, the book brings to light the need for continued research in the area of therapeutic physical agents.

Rose L Smith, PT
University of Cincinnati
Cincinnati, Ohio

Ms Smith is Assistant Professor in the
Department of Rehabilitation Sciences,
Adjunct Professor in the Athletic Training
Program, and Health Alliance Rehabilitation
Specialist for the University of Cincinnati
Athletic Department.