Physiotherapy September 1999/vol 85/no 9

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Bring in the Experts

PHYSIOTHERAPISTS are ‘experts’ whenit comes to the use of exercise as anintervention in the treatment of manyconditions (Hunt et al, 1999). We areexperts because we probably prescribe itat least once a day. As such we follow theguidelines or principles that areinternationally recognised -- or do we?

I am still amazed that when we prescribeexercise in our studies hardly any of it isreproducible.

Exercise prescription is a science and an art. The American College of SportsMedicine tells us that it involves theapplication of exercise science withbehavioural techniques that result in long-term adherence and attainment of anindividual’s goals.

The College gives us a framework whichI call on all those doing research to use: 1. Assessment and aim; 2. Mode oftraining; 3. Intensity; 4. Duration; 5. Frequency; and 6. Progression.

Then we can compare the use ofexercise in treatment of commonconditions such as osteo-arthritic kneesand low back pain (Hilde and Bo, 1998).And then maybe we can make progress.

The Personal Trainers Association istrying to develop the role of ‘clinicalexercise practitioner’, so it is particularlyimportant to defend and protect our roleas ‘experts’.

Matthew Daly MCSPRichmond, Surrey

References

Hunt, K D, Leighton, M L and Reed, G M(1999). ‘Intermitten claudication:Implementation of an exerciseprogramme’, Physiotherapy, 85, 3, 149-153.

Hilde, G and Bo, K (1998). ‘Effect ofexercise in the treatment of chronic lowback pain: A systematic reviewemphasising type and dose of exercise’,Physical Therapy Review, 3, 107-117.

Interferential EffectsWE are responding to the article in theJune journal about the effects ofinterferential currents (IFC) (Johnson,1999).

Dr Johnson has ably addressed the lackof evidence for the claims made in thephysiotherapy literature for the effects ofIFC. A further criticism may be made ofthe quotation from Savage (1992) in thatit is simply incorrect to say: ‘Frequenciesof 10-150 Hz stimulating theparasympathetic nerves increase the bloodflow through the part assisting inresolution’ (Savage, 1992, page 60,‘Reduction of bruising’).

The parasympathetic outflow is fromcranial nerves 3, 7, 9, 10 and 11 and sacralspinal nerves 2, 3 and 4 and has no directeffect on the peripheral system.

The typical peripheral nerve comprisesmotor sensory and sympathetic fibres andno parasympathetic fibres.

Vasodilation in the periphery isgoverned by stimulation of the sympatheticbeta receptors and constriction of thesympathetic alpha receptors.

It seems that in this context alone, thecause of the effect is not by stimulation ofthe parasympathetic nerves, but by someother means.

The mystique continues.

Karen Mcllveen MCSPJim Muirhead MCSPOutpatient Physiotherapy ServiceGreenwich District Hospital

References

Johnson, M I (1999). ‘The mystique ofinteferential currents when used tomanage pain’, Physiotherapy, 85, 6, 294-297.

Savage, B (1992). Interferential Therapy,Wolfe, London.

General letters

Information andKnowledge

LIKE Katrina Bannigan (Letters, July), mywork involves journal club facilitation,and I empathise with her comments onthe language in which research papersare written.

I have found it useful to consider thedistinction between information andknowledge (National electronic Libraryfor Health (NeLH) URL). The literaturebase in physiotherapy contains bothinformation (articles published inscientific journals) and knowledge(information which has been synthesisedfor ease of use, eg systematic reviews).The provision of commentaries onresearch papers could be viewed as anattempt to move information towardsknowledge. The balance between therelative need for information andknowledge, and the skills required toutilise them, will vary over the course ofprofessional life.

One way of helping research andpractice to influence one another is tostress their similarities as processes ofsystematic inquiry (Jones et al, 1999).Reducing the mystique of the researchprocess allows the practice context tobecome a rich environment to explorepractice-based issues within a culture ofinquiry that grows research capacity inclinicians.

Diana Jones MCSPResearch PhysiotherapistInstitute of Rehabilitation University of Northumbria

References

NeLH URL:http://www.nelh.nhs.uk/knowled.htm

Jones, D, Harrison, S, Plant, R, Chandler, C and Whittaker, C (1999).‘Research spirals as a paradigm to linkresearch and practice’, 13th InternationalCongress of the World Confederation forPhysical Therapy, Japan.