Availability and use of electrotherapy devices: A survey. Syed Ghulam Sarwar Shah, Alexandra Farrow, Alan Esnouf

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1 Cliical Availability ad use of electrotherapy devices: A survey Syed Ghulam Sarwar Shah, Alexadra Farrow, Ala Esouf Electrophysical agets such as radiofrequecy electromagetic fields (shortwave ad microwave), ultrasoud, laser ad electrical stimulatio are used for therapeutic purpose i physiotherapy departmets. They are primarily used for treatig a wide rage of musculoskeletal ijuries. This study ivestigated the availability ad use of therapeutic diathermy, ultrasoud, laser, trascutaeous electrical erve stimulatio () ad iterferetial equipmet i 46 physiotherapy departmets i NHS hospitals i the south of Eglad, usig a self-admiistered questioaire. Results idicated that therapeutic ultrasoud was the most commoly available ad most ofte used modality by surveyed departmets. Pulsed shortwave diathermy, iterferetial, ad laser were available to a lesser degree ad also used less ofte. Cotiuous shortwave diathermy was used rarely ad oly i larger departmets. Microwave diathermy was ot available i ay of the surveyed departmets. The level of o-use of equipmet despite availability was highest for cotiuous shortwave diathermy followed by pulsed shortwave diathermy ad the laser. The rare use ad total o-use of some of the modalities, despite availability of equipmet, may have implicatios for purchasers of this expesive equipmet. While the fidigs of this study show a regioal tred i NHS physiotherapy departmets, this may ot be geeralizable to a atioal level. Key words: Electrotherapy, electrophysical agets, equipmet, Natioal Health Service, physiotherapy, survey. Shah S, Farrow A, Esouf A (7) Availability ad use of electrotherapy devices: A survey. It J Ther Rehabil 14(6): Syed Ghulam Sarwar Shah is Research Fellow, Alexadra Farrow is Seior Lecturer ad Course Director MSc Occupatioal Health & Safety Maagemet ad Ala Esouf is Registered Physiotherapist ad Lecturer i Physiotherapy, School of Health Scieces ad Social Care, Bruel Uiversity, Uxbridge, Middlesex, UB8 3PH, UK Correspodece to: S Shah Sarwar.Shah@bruel. ac.uk Electrotherapy is a essetial compoet of physiotherapy (Watso, ) ad comprises applicatio of differet forms of electrophysical agets (EPAs) for therapeutic purpose. EPAs are applied by microwave diathermy (MWD), shortwave diathermy (SWD), iterferetial, trascutaeous electrical erve stimulatio (), ultrasoud ad laser equipmet. SWD is used i either pulsed () or cotiuous () mode. A list of the abbreviated agets ca be foud i Box 1, ultrasoud ad laser are used for bio-stimulatio of tissue. ad MWD are used for heatig of tissues to promote healig ad resolutio of musculoskeletal ijury. ad iterferetial are used for electrical stimulatio of muscle erves to alleviate pai due to musculoskeletal ijury (Fox ad Sharp, 7). Discussio about the mechaism of applicatio ad resultat therapeutic effects of these modalities is beyod the scope of this paper ad readers should cosult the relevat literature. Accordig to Kitche ad Partridge (1997), the use of ay electrotherapy modality depeds o the availability of equipmet. A survey of owership ad use of various electrotherapy modalities i NHS physiotherapy departmets by Pope et al (1995) foud that ultrasoud,, iterferetial ad were the four most commoly owed ad used modalities. The survey did ot report total o-use of ay of the surveyed electrotherapy modalities. Kitche ad Partridge (1996) studied availability ad use of ultrasoud,, ad laser i physiotherapy outpatiet departmets i the NHS i Eglad. They reported that ultrasoud was available i all respodig departmets ad that, ad laser were available i 98%, 85% ad 33% of respodig departmets, respectively. They foud that ultrasoud, ad were used more tha oce a week by 76%, 72% ad 16% of departmets respectively ad the use of ad was lower tha ultrasoud i all surveyed 2 Iteratioal Joural of Therapy ad Rehabilitatio, Jue 7, Vol 14, No 6

2 departmets. Accordig to Grat (1), the use of ad MWD has almost disappeared i the last few years, whereas is still used i physiotherapy departmets. I additio, oe of the authors (AE) has observed a chage i usage of electrotherapy modalities, particularly ad MWD, whe visitig physiotherapy studets i various departmets i the south of Eglad. However, the exact status of curret use of EPAs i cliical practice, especially i NHS physiotherapy departmets, is ot available. To determie curret electrotherapy practice, it is importat to ivestigate the availability ad use of equipmet used for therapy with EPAs. The objectives of this study were therefore to ivestigate the availability ad frequecy of use of the followig modalities i NHS physiotherapy departmets i the south of Eglad: SWD MWD Ultrasoud Iterferetial. METHODS Desig Usig a self-admiistered questioaire, a cross-sectioal survey was carried out i 46 NHS hospital physiotherapy departmets ad cliics i the south of Eglad. The umber of departmets selected was limited due to fudig; however, all 46 departmets were visited by the authors to validate the iformatio reported ad esure the quality of data, as well as to study departmetal practices from the health ad safety remit of this project (ot described here). Participat recruitmet A list of 17 physiotherapy departmets located i the south of Eglad was obtaied from the physiotherapy sectio of the Departmet of Health ad Social Care at Bruel Uiversity. From this list, a stratified radom sample of 57 departmets i various NHS hospitals i Greater Lodo ad 12 couties i souther Eglad was selected. Selected departmets icluded large departmets Box 1. List of abbreviatios for electrophysical agets MWD SWD Cotiuous Shortwave Diathermy Microwave Diathermy Pulsed Shortwave Diathermy Shortwave Diathermy Trascutaeous Electrical Nerve Stimulatio i urba cetres as well as small commuity cliics. Departmets were cotacted by telephoe ad letter; ad the physiotherapy maager or superitedet physiotherapist was requested to complete a coset form regardig participatio i the study. Two departmets replied statig that they were ot iterested i the study ad ie departmets did ot respod. After receipt of coset, 46 departmets were set a self-completio survey questioaire, a coverig letter ad istructios for completig the questioaire. I particular, the letter requested that the respodet completig the questioaire would do so after cosultig with members of the departmet who used the electrotherapy equipmet most ofte. Ethical approval Ethical approval for this study was obtaied from the Multi-cetre Research Ethics Committee (Wales), Research Protocol 2/9/4 ad the Ethics Committee at Bruel Uiversity. Survey istrumet A survey questioaire was developed i-house that requested the umber of devices available, their use ad the frequecy of use i the departmet. The questioaire cotaied mostly closed questios. A Likert scale questio raked the frequecy of use of differet types of modalities o a ie-poit scale, i.e. poit oe for the most commoly used modalities ad poit ie for the most rarely used modalities. The questioaire was validated before admiistratio by pilotig amog staff i the Departmet of Health Studies ad Social Care at Bruel Uiversity. The fial versio of the questioaire is available from the authors. Data compilatio ad aalysis The data were collected from October 2 to July 3. Frequecies ad descriptive statistics usig the Statistical Package for Social Scieces (SPSS) for Widows (versio13) were used for the aalysis. RESULTS Availability ad umber of electrotherapy devices The availability ad umber of devices by type of electrotherapy modality are show i Figure 1. Ultrasoud equipmet was available i all respodig departmets ( = 46) whereas MWD equipmet was ot available i ay departmet. The umber of various types of electrotherapy devices available i the departmet is show i Figure 2. The maximum umber of devices per departmet was 88 for, 14 for ultrasoud, 6 for, 5 for iterferetial, 3 for ad 2 for laser. Iteratioal Joural of Therapy ad Rehabilitatio, Jue 7, Vol 14, No 6 261

3 Cliical Departmet (%) Iterferetial The authors divided departmets ito small departmets (havig te or fewer full-time physiotherapists) ad large departmets (havig more tha te full-time physiotherapists). Results showed that the departmet size was sigificatly ad positively related (r =.374, P =.5) to the umber of ultrasoud devices oly ad ot related to the umber of ay other type of device. Figure 1. Availability of electrotherapy devices i departmets 1 Available Not available Departmets (%) Figure 2. Number of electrotherapy devices available i the departmet 1 Ultrasoud Iterferetial Ultrasoud LASER CWSD >6 Figure 3. Use of electrotherapy modalities i departmets that had the devices Used Not used Iformatio ot provided MWD Use of equipmet The use of electrotherapy modalities i departmets where equipmet was available is show i Figure 3. The use of equipmet varied betwee departmets despite the availability of equipmet. The modality used by the greatest umber of departmets ( = 37,.4%) was ultrasoud ad the modality used by the least umber of departmets ( = 4, 8.7%) was. No-use of modalities despite availability was highest for followed by ad the laser. was used i large departmets oly. Despite the availability of equipmet it was ot used i small departmets. was used i both small ad large departmets, ad the o-use of was greater i large departmets. No-use of laser despite availability was oly foud i small departmets. Frequecy of equipmet use Figure 4 shows the rakig of the frequecy of use of the various modalities reported by departmets o a Likert scale from most commoly used (rak first) to least used (rak ith). The greatest umber of departmets raked the use of ultrasoud, ad iterferetial as first choice, the use of as secod choice ad the use of as sixth choice. A equal umber of departmets raked the use of laser as first ad secod choices. DISCUSSION The recruitmet rate i this study was 81% (46 out of 57 departmets); however, all 46 departmets that agreed to take part i the study completed ad retured the survey questioaire. Thus, the respose rate was 1%. Results idicate that ultrasoud, iterferetial ad devices were the most commoly available ad most used modalities i the surveyed departmets. However, because of the regioal ature of this survey these fidigs caot be assumed to represet the rest of the UK. Departmets (%) Ultrasoud Iterferetial LASER Ultrasoud Use of therapeutic ultrasoud i Britai was foud i 25% of NHS hospitals (ter Haar et al, 1987). Pope et al (1995) reported that all of the NHS physiotherapy departmets surveyed i Eglad owed ad used ultrasoud. High frequecy of use of ultrasoud i Eglad was also reported by Turer ad Whitfield (1997a) ad Kitche ad Partridge (1996; 1997). The preset study foud that ultrasoud is still the most commoly available ad used electrotherapy modality, i agreemet with previous studies (Lidsay et al, 199; 1995; Pope et al, 1995; Kitche 262 Iteratioal Joural of Therapy ad Rehabilitatio, Jue 7, Vol 14, No 6

4 ad Partridge, 1996; 1997; Robertso ad Baker, 1). The study also foud that ultrasoud devices were available i all respodig departmets ( = 46) with oe of the departmets reportig o-use of this modality. Iterferetial I 1995, Pope et al reported that iterferetial with electrodes ad iterferetial with suctio electrodes were available i 95% ad 86%, respectively, ad used by 99.5% ad 9% departmets, respectively, where equipmet was owed. The preset study did ot request iformatio regardig the availability ad use of iterferetial by type but as iterferetial oly. Results showed that this modality was available i 96% departmets ad used by % of departmets that had the equipmet. This suggests that there has bee a declie i the use of this modality sice I the preset study, the use of was less tha that reported by Pope et al (1995). This idicates that the use of has decreased i the NHS departmets surveyed i this study. SWD: ad I their 1 study, Shields et al reported that the maximum umber of SWD devices per departmet was three; however, they did ot provide a break-dow betwee ad. Lidsay et al (199; 1995) ad Cooey et al () reported greater availability of tha devices. However, the preset study foud availability of devices to be higher tha ; with a maximum of three devices for ad eight devices for, per departmet. Accordig to Al-Madeel ad Watso (6), SWD is widely used i the UK. Shields et al (1) reported the use of ad to be equal i Irelad. However, i the preset study the umber of departmets that used was greater tha those that used. The greater use of compared to i NHS departmets may be due to preferece for use of o-thermal modalities by physiotherapists i Britai (Kitche ad Partridge, 1996). I the preset study, the availability ad use of laser was lower tha that reported by Pope et al (1995) who foud laser equipmet available i 52% departmets ad used by 86% departmets that owed the equipmet. The umber of laser devices per departmet i the preset study was i accord with McMeeke ad Stillma (1993), who foud a maximum umber of three laser devices per departmet. However, use of laser i departmets where devices were available was higher i the preset study tha that reported by Lidsay et al (199). I the preset study, the use of laser was greater tha use of but less tha ultrasoud ad, i accordace with the fidigs of Kitche ad Partridge (1996). No-use despite equipmet availability No-use of MWD despite availability of the equipmet i some departmets was reported by Ide ad Partridge (1986) ad Pope et al (1995). The preset study cofirms previous fidigs that there is o-use of ad despite equipmet availability i some departmets (Pope et al, 1995; Shields et al, 1). However, ouse of ad was higher tha that reported by Pope et al (1995). The preset study also highlights o-use of laser despite availability of the devices. The authors did ot ask for reasos for the o-use or the rare use of the surveyed modalities. Kitche ad Partridge (1996) have argued that the use of electrotherapy modality depeds o the availability of the equipmet. However, like may previous studies (Ide ad Partridge, 1986; Pope et al, 1995; Shields et al, 1), the preset study s fidigs reveal ouse of some of the modalities despite the availability of equipmet. This suggests that the use or o-use of electrotherapy modalities is determied ot oly by the availability of equipmet but also by other factors. The followig factors have bee suggested: Issue of efficacy (Kitche, 1995; Robertso ad Spurritt, 1998) Physiotherapist s choice (Pope et al, 1995) Kowledge of a particular modality (Turer ad Whitfield, 1997b; 1999) Safety cocers (Larse et al, 1991; Ouellet- Hellstrom ad Stewart, 1993; Robertso ad Spurritt, 1998; Lerma et al, 1) The ature of the cliical coditio beig treated (Kitche ad Partridge, 1996). Figure 4. Frequecy of use of electrotherapy modalities raked by departmets Departmets (%) 1 Ultrasoud Iterferetial 1st 2d 3rd 4th 5th 6th 7th 8th 9th Rak Iteratioal Joural of Therapy ad Rehabilitatio, Jue 7, Vol 14, No 6 263

5 Cliical CONCLUSION This study ivestigated the availability ad use of various electrotherapy modalities for treatmet i a sample of NHS physiotherapy departmets i Greater Lodo ad 12 couties i south Eglad. The availability ad use of the equipmet was foud to vary betwee surveyed departmets. Therapeutic ultrasoud was the most commoly available ad most commoly used modality, whereas MWD was ot available at all. The order of frequecy of use was as follows: 1. Ultrasoud 2. Iterferetial The o-use of, ad laser despite equipmet availability i some NHS physiotherapy departmets i south Eglad has importat implicatios for purchasers of such expesive devices. However, further ivestigatio is warrated as this may be a regioal tred, which may ot be geeralized throughout the UK. IJTR This study was fuded by Health & Safety Executive, UK (Grat. No. 4371/R47.22). The authors wish to thak all the physiotherapists icludig maagers ad superitedets withi NHS physiotherapy departmets for their time i takig part i this study. The authors ackowledge helpful commets from the Iteratioal Joural of Therapy ad Rehabilitatio s aoymous reviewers. Coflicts of iterest: oe. Al-Madeel MM, Watso T (6) A audit of patiet records ito the ature of pulsed shortwave therapy use. Iteratioal Joural of Therapy ad Rehabilitatio 13: 414 Cooey M, Mullis G, Galle C () A survey of electrotherapy modalities: public ad private practices i the Republic of Irelad. Physiotherapy Irelad 21: 3 8 Fox JE, Sharp TN (7) Practical Electrotherapy- A Guide to Safe Applicatio. Churchill Livigstoe, Philadelphia, PA. Grat L (1) Radio frequecy i physiotherapy. I: Abstracts of IPEM meetig Electrotherapy - Cliical Effectiveess, Safety ad Quality Assurace Birmigham. Istitute of Physics ad Egieerig i Medicie (IPEM), 17 May: Ide L, Partridge CJ (1986) A survey of electrotherapy equipmet i physiotherapy departmets ad private practice. The Chartered Society of Physiotherapists, Lodo Kitche SS (1995) Ultrasoud, shortwave diathermy ad laser treatmet: a exploratory iterview study. British Joural of Therapy ad Rehabilitatio 2: Kitche SS, Partridge CJ (1996) A survey to examie the cliical use of ultrasoud, shortwave diathermy ad laser i Eglad. British Joural of Therapy ad Rehabilitatio 3: Kitche SS, Partridge CJ (1997) Ultrasoud, shortwave diathermy ad laser: a survey to examie patters of use i Eglad. British Joural of Therapy ad Rehabilitatio 4: Larse AI, Olse J, Svae O (1991) Geder-specific reproductive outcome ad exposure to high-frequecy electromagetic radiatio amog physiotherapists. Scad J Work Eviro Health 17: Lerma Y, Jacubovich R, Gree MS (1) Pregacy outcome followig exposure to shortwaves amog female physiotherapists i Israel. Am J Id Med 39: Lidsay D, Dearess J, McGiley C (1995) Electrotherapy usage treds i private physiotherapy practice i Alberta. Physiother Caada 47: 3 34 Lidsay D, Dearess J, Richardso C, Chapma A, Cuskelly G (199) A survey of electromodality usage i private physiotherapy practices. Aust J Physiother 36: McMeeke J, Stillma B (1993) Perceptios of the cliical efficacy of laser therapy. Aust J Physiother 39: 11 8 Ouellet-Hellstrom R, Stewart WF (1993) Miscarriages amog female physical therapists who report usig radio- ad microwave-frequecy electromagetic radiatio. Am J Epidemiol 138: Pope GD, Mockett SP, Wright JP (1995) A survey of electrotherapeutic modalities: owership ad use i the NHS i Eglad. Physiotherapy 81: Robertso VJ, Baker KG (1) A review of therapeutic ultrasoud: effectiveess studies. Phys Ther 81: Robertso VJ, Spurritt D (1998) Electrophysical agets: implicatios of their availability ad use i udergraduate cliical placemets. Physiotherapy 84: Shields N, Gormley J, O Hare N (1) Short-wave diathermy i Irish physiotherapy departmets. British Joural of Therapy ad Rehabilitatio 8: ter Haar G, Dyso M, Oakley EM (1987) The use of ultrasoud by physiotherapists i Britai, Ultrasoud Med Biol 13: Turer PA, Whitfield TWA (1997a) A multidimesioal scalig aalysis of the techiques that physiotherapists use. Physiother Res It 2: Turer PA, Whitfield TWA (1997b) Physiotherapists use of evidece based practice: a cross-atioal study. Physiother Res It 2: Turer PA, Whitfield TWA (1999) Physiotherapists reasos for selectio of treatmet techiques: a cross-atioal survey. Physiother Theory Pract 15: Watso T () The role of electrotherapy i cotemporary physiotherapy practice. Ma Ther 5: KEY POINTS This survey showed that microwave diathermy was ot available i ay of the surveyed departmets. Ultrasoud, iterferetial, pulsed shortwave diathermy, trascutaeous electrical erve stimulatio ad laser were used by more tha 7% of departmets that had the equipmet. Cotiuous shortwave diathermy was used rarely ad i larger departmets oly. I some departmets, cotiuous shortwave diathermy, pulsed shortwave diathermy ad laser were ot used despite availability of equipmet. The use or o-use of electrotherapy modalities is ot depedet o the availability of equipmet oly but other factors are also ivolved. No-use of, ad laser equipmet despite availability may have implicatios for the purchasers of this expesive equipmet. 264 Iteratioal Joural of Therapy ad Rehabilitatio, Jue 7, Vol 14, No 6