ultrasound therapy in joint mobilzation

[Ontogenese]

Dear SMSHAFFE,

first off, thank you for the interesting articles. I miss, however, the method and result section; personally I prefer those above the conclusion.
Second, I completely agree with you that US is most likely a doubtful treatment modality, at best. However, alot of studies that investigated US had little or nothing to do with the daily practice of the physiotherapist; a very prevalent problem in physiotherapy research. Considering the latter, one should ask him-/herself whether a randomized clinical trials is the optimal design for physiotherapy research. I don't think so, therefore I am very pleased to see more and more naturalistic trials embark in our field.
But I am wondering of... what were we talking about...

Regards,

Thomas

[smshaffe]

the topic at hand is using mobilization and US together. we both apparently agree that there is little added benefit from using US. mobilization and stretching is the key here if ROM is to be gained. additionally, I point out that we have to keep up on research. i doubt a physical therapist or any medical professional can practice at their best potential without keeping up on research. as for the articles i posted, this is no forum to cut and paste entire publications. if you would like to read anything i posted let me know and i can email it to you if you do not have access otherwise.

what form of research do you propose replaces RCTs? PT is hard to research because it is hard to have (if not impossible in most scenarios) a double blind scenario unlike pharmacology etc. it is also difficulty to quantify “impairment based” treatment which is really what we do (or should be doing instead of using US). for now the research we have is the best option to keep us informed and it is not likely to change any time soon despite the fact that a lot of it is crap.

[Ontogenese]

In my opinion, physiotherapy research will shift from RCT's to more advanced observational trials. If you look at the latest cochrane handbook (Cochrane Handbook for Systematic Reviews of Interventions) you will see the implementation of the GRADE approach to evaluate the body of evidence.
According to this approach a properly executed randomized trial is rated qualitatively as high as a double-upgraded observational study. Moreover, the upcoming use of computers by physiotherapists will result in the increase use of outcome measures and finally faclitate research projects in the actual physiotherapist's environment.