Physiotherapy, vol 14, Controlled Trials and Facts.

Physiotherapy: Controlled Trials and Facts, Vol 14 Schlapbach P, Gerber NJ; Schattenkirchner M, Hagena FW, eds. Basel, Switzerland, Kargers AG, Medical and Scientific Publishers, 1991, hardback, 252 pp, illus, $78.50.

The editors and authors of this unique text focus on the increasing demands for physical therapy and the pressing need to critically evaluate clinical practice. This text emphasizes the need for controlled prospective randomized trials in physical therapy such as are mandatory prior to drug administration. The method used to summarize present-day knowledge is to highlight facts about clinical physical therapy practice that have been established from good research and to debunk other assumptions that have inadequate scientific grounding. Multiple authors of the 21 chapters critique selected literature on the practice of musculoskeletal physical therapy related to eight dysfunctional conditions and six selected treatments. The book is a valuable resource for educators, clinicians, and students in medicine and physical therapy who seek to validate clinical practice. The book is organized into four parts, of which the middle two contain the reviews of physical therapy literature. Part 1 addresses methodological and statistical requirements from the perspectives of a clinician and a statistician. These two chapters are well organized and of interest, but are not different from what is found in many good texts on research design. Inclusion of the material is warranted because it sets the framework for the next two parts of the book in which each chapter reinforces the necessity for good research design. Part 2 contains reviews of articles addressing the efficacy of physical therapy for low back pain three chapters), osteoporosis two chapters), scoliosis, spondylitis, shoulder pain, tennis elbow, chronic knee and hip pain, and certain respiratory conditions. Chapter authors describe the physical therapy problems being addressed with each condition, review recent articles, and summarize what they conclude about the efficacy of physical therapy intervention. Comparative tables provide visual summaries of results of various studies. Part 3 follows the same approach, analyzing the effectiveness of cryotherapy, analgesic low-frequency electrotherapy, ultrasound, acupuncture, laser, and muscle training. One chapter in this part addresses literature pertaining to mechanisms of action, whereas the others focus on functional outcomes. Part 4 is one final chapter that examines the psychological aspects of physical therapy. This chapter is a fitting conclusion, as many of the authors of other chapters attribute some of the success of treatment in physical therapy to unexplained psychological factors. All contributing authors are from academic or clinical settings in Canada, The Netherlands, Switzerland, Belgium, Germany, or the United Kingdom. Presumably, most are writing in English as their second language. The syntax is relatively readable and consistent in all of the chapters, with the exception of two chapters written by one author. The literature selected is reasonably current throughout most of the book. No chapter is exhaustive; each author has selected the references believed to be the most pertinent to the topic. Where duplication of content occurs (for example, acupuncture is discussed in part 2 for chronic knee pain and again in part 3 as a specific method), different references are cited, but the authors' conclusions are similar. Good indexing enhances the usefulness of the material and enriches the content, which naturally spans more than one chapter. Given the emphasis on good scientific design, the occasional statements supported by old references (1960), those not supported by any references, and those that are unnecessarily disparaging (for example, the use of "amazingly!") are jarring. The international composition of the authors reflects a broad perspective of experience and a common concern for clinical validity. None of the chapters provides a definitive answer to questions raised, but there are several chapters that stand out as superlative examples of literature synthesis. At a time when consumers, clinicians, and third-party payers are demanding evidence of clinical efficacy, this text provides a resource for basing clinical decisions on controlled systematic studies rather than on personal testimonials. I highly recommend the book for clinicians, educators, and students in physical therapy and in medicine.

Mary T Moffroid, PhD, PT Univ of Vermont Burlington, Vt