We Need to Limit Our Use of Modalities
In the most recent print issue of Advance for Physical Therapists and PT Assistants
(vol 19, # 18, p. 138) the Rehab Roundtable section poses an interesting question. Should physical modalities be removed from physical therapy practice? This is a legitimate question. Modalities, particularly ultrasound, are overused. The question was put out to a panel of four. They were unanimous in their answer of no. They were also unanimous in stating that modalities are useful when used properly, but this is often not the case. They also agreed more research is needed because the current evidence is ambiguous.
This got me thinking. My answer to the question is a definite maybe. It depends upon who is using the modality and why it is being used. In a perfect world there wouldn't be an uncertainty about the use of modalities. But our world is not perfect and modalities are misused. The issue questions our clinical judgment. Taking modalities from our treatment arsenal would be seen as an insult to our skills and reasoning. How can something be a skilled service when it is used for just about anything and performed by a technician? Under those circumstances I can see why the question would be raised.
Why are modalities used so much? There is the obvious reason why they are very effective when used correctly. I thought of some additional reasons that don't reflect well on those guilty of overuse. Using modalities makes the patient feel like something has been done. Modalities are a billable unit. There is lack of knowledge of more appropriate alternatives. A tech can perform the treatment so the therapist is freed up to do something else. And, of course, because that's what the doctor ordered. The last one is of a different nature and results from lack of knowledge on the part of the MD not the therapist.
Look at the remaining reasons. Doing something solely because it is billable raises an ethical question I'd just as soon avoid. The rest are easily rebukes. There are other ways to make a patient feel something has been done. Some continuing education on the subject can correct a knowledge deficit. If a treatment is done only because a non-licensed tech can perform it indicates to me little thought went into the POC. That's similar to everyone with this diagnosis gets the treatment, so this patient should too. None of these are valid reasons for using a modality.
I don't know one therapist who would answer yes to the question. My gut reaction is no. My thought out reaction is no, but we need to be more responsible in how modalities are used. Use of modalities should be individualized and based on diagnosis and expected outcome and not a generalized treatment. If therapists as a whole rein in overuse of modalities the question becomes moot. It will no longer be a problem.