Physical modalities in musculoskeletal disorders : evidence-based?
Vanderstraeten, G. ; Muynck, M. de ; Kaymak, B.
A variety of physical modalities is applied for musculoskeletal disorders, but the efficacy of these passive interventions is still controversial. Despite the physiological effects, there are either ...no clinical data or there is insufficient clinical information on the effectiveness of many techniques used in electrotherapy. As a consequence we are often unable to make a clinical recommendation regarding specific interventions. Because of these often disappointing results based on evidence-based research in electrotherapy, the Belgian government decided not to reimburse a large number of these treatments. Interventions with proven effectiveness through clear evidence in randomized clinical trials, and with a good risk-benefit ratio, are rather limited as far as musculoskeletal disorders are concerned. Most studies on low-frequency, medium-frequency (including interferential current) and high-frequency currents show a lack of clinical scientific evidence, which contrasts with the frequent use of electrotherapy all over Europe. Application of these therapies should be further evaluated. Most studies are flawed by a lack of uniformity (parameters, frequency, duration...) Double-blind studies are not always possible and the diagnosis is not always very clear. There is a need for more objective clinical strategies. We should also put into perspective, some of the results because when there is no clear evidence for a specific treatment, it does not mean that it does not work.
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