Ultrasound therapy and metal implant

[zisuer]

I am not the fan who like use modalities. We don't need too many trials to make the decision. We only need one trial which is good enough and big enough.

[gcoe]

Yes I agree. if it is a really well designed large trial that shows no benefit – then that will often convince me – unless there happens to be an equally well designed large trial that does show benefit.

However if there is a really well designed large trial that does show clinically significant benefit then I would be encouraged but I would still want to see the study replicated by an independent team, before being convinced. I would remain sceptical until I saw the replicated evidence because we just seem so good at fooling ourselves that our treatments are effective when they turn out not to be the case.

So why do we keep trundling the US unit out despite the evidence of no effect. I think the reason why people won’t give up on US is that it is such a good placebo:

• It is an impressive looking metal box with leads, buttons knobs and readouts that light up and flash.
• There is the ritual of putting on the gel on the head and also on the painful part
• Then gently rubbing the painful part while the machine knowingly keeps flashing lights at the patient and giving out readouts
• And all the time the therapist is by the patient concentrating on the act of healing.

I am sure if it made a nice whooshing sound and they added some more flashing lights it would work even better.

[zisuer]

Hehe. It is fun to read your tread. Anyway, you have bias, hehe. I agree with your opinion, but either way, I would like see another trial to confirm the first trial. Before we have any evidence, don't think we fool ourself. As to placebo, I remember one guy who told us that he likes placebo effect and if he can he want to enhance the placebo effect, because it can benefit patient anyway. Different attitude , eh?

Seriously, there are quite a few systemic review showed that US is no effect, but the trials included in these review either small or different dose, insuficcient treatment time. Therefore, using these evidence to prove the effective of US is not convincing. Even I only use US when I don't know what I should do. hehe.

May I ask you one extra question, what do you thinK PT can do for ganglion ( painful)? The effectiveness?