Effectiveness of physical therapy; electrotherapy, lasertherapy, ultrasound therapy
In the Netherlands, physiotherapists often use so-called physical therapy in the restricted sense – i.e. forms of treatment in which various types of apparatus are used to provide a physical stimuli – particularly in the treatment of musculoskeletal disorders. People suffering from such disorders constitute the largest patient group for physiotherapy treatment in primary health care. Within the Netherlands it is estimated that such apparatus is used, either on its own or in combination with other forms of physiotherapy, in more than half of all cases where extramural physiotherapeutic treatment is given.
Although physical therapies are in widespread use, more and more experts have in recent years questioned how effective they are. A committee of the Health Council has accordingly been studying three recently completed systematic reviews, in order to establish what conclusions could be drawn regarding the effectiveness of electrotherapy, lasertherapy and ultrasound therapy.
In total, the reviews covered 169 randomized clinical trials (RCTs). From the reviews it is apparent that, with a few exceptions, there is little or no evidence that the therapies concerned are effective in the treatment of a wide range of conditions. The lack of convincing scientific evidence is in sharp contrast with the relatively large-scale and frequent use of these therapies in the Netherlands. Therefore, the committee concludes that their widespread use in mainstream care is not justified.
Continued use of the three therapies is justifiable for the treatment of the small number of conditions where there is (some) evidence to suggest that they are effective. However, the committee believes that, with a view to promoting the quality and efficiency of care, the application of these therapies should be further evaluated. The applications concerned are electrotherapy for the treatment of arthrosis, lasertherapy for pain relief and the treatment of rheumatoid arthritis and, ultrasound therapy for the treatment of "tennis elbow".
Since use of the three therapies has been "accepted" practice in the Netherlands for some years, the committee will entrust the professional organizations for physiotherapy with initiating a policy to encourage their members to change their procedures. These efforts should preferably tie in with the quality improvement initiatives (involving, for example, the formulation and revision of guidelines) that the professional bodies have been developing in recent years. The content of basic and in-service training courses for physiotherapists should also take account of the committee’s findings.
The committee’s conclusions and recommendations relate exclusively to the specified forms of therapy. Therefore the possibility that other common forms of physiotherapy, such as exercises, supervision and instruction, are effective, is not excluded. Further research is needed to determine the effectiveness of such therapies.