If I had evidence that can prove a certain modality does not work as prescribed, would you still use it? And if a large insurance company deemed a treatment "experimental and investigational" and refused reimbursement for it, would you still use it?
I guess it would depend on what modality and treatment, right? First the modality, ultrasound. After consideration of evidence and a thorough reading of clinical trials, ultrasound may not be too effective. I read the study about increasing hand grip in RA patients (along with other studies) that sounded promising but what about decreasing musculoskeletal pain and healing soft-tissue injury? I found little to effectively support its use. I did find multiple studies that proved ultrasound assisted healing in patients with venous and pressure ulcers (great job Bell and Cavorsi) along with good results for some fractures and incision sites. So I guess the question is, outside of wound care, when would ultrasound be used most effectively?
Then there is a certain large insurance company that will pay for ultrasound but will not pay for an effective taping technique. I have seen better patient results in a clinic with taping than I did with an ultrasound head. So do I conduct the treatment that would be most beneficial and effective for the patient or the treatment that gets reimbursed the most by the insurance company? The dilemma of patient care. And what if the person who ordered the treatment technique (i.e., MD, physiatrist or PT) insists on doing a technique that is not as effective? Similar to the CPM machine and Hubbard tank for wound care.
And then I start thinking about the clinics that are modality-free. If they can effectively treat patients by limiting modality use, why can't others? Or maybe it could be the other way around. Now I'm not sure what I read or who is right. Any thoughts?