Chapter 1: Therapeutic Modalities Past, Present, and Future: Their Role in the Patient Care Management Model

THERAPEUTIC MODALITIES: ROLES IN REHABILITATION

Therapeutic modalities represent the administration of thermal, mechanical, electromagnetic, and light energies for a specific therapeutic effect; for example, to decrease pain, increase range of motion (ROM), improve tissue healing, or improve muscle activation. The terms therapeutic modalities and physical agents are often used interchangeably to describe a wide array of treatments and interventions that provide a variety of therapeutic benefits. The term physical agents reflects the use of physical energies—such as thermal, mechanical, electromagnetic, or light—but fails to include the purpose or intention of their application. The term therapeutic modalities, as used throughout this text, more appropriately reflects the ability of these interventions to provide therapeutic benefits.

Therapeutic modalities have long been, presently are, and will continue to be a part of rehabilitation and are used to complement other elements of the more comprehensive patient care plan, such as therapeutic exercise (e.g., strengthening, stretching, neuromuscular reeducation, balance), manual therapy (e.g., joint and tissue mobilization, manipulation), and patient education (e.g., body mechanics, postural retraining, home exercise program, risk reduction). Cold therapy and compression may be used in the early phases of rehabilitation to limit swelling and pain that a patient may experience following acute injury or surgery. Continuous ultrasound or other heat therapy may be applied to improve elasticity of ligaments or joint capsular structures before beginning ROM activities in a patient who has deficient ROM. Electrical stimulation may be used to increase activation and facilitate volitional recruitment of skeletal muscle until the patient can effectively contract the muscle and begin additional activities. These examples reflect the complementary use of modalities to achieve clinical goals. Because the effectiveness of these treatments may vary from patient to patient, the practitioner is challenged to identify those patients who are more likely to respond to a specific intervention. In this manner, the practitioner must consider or judge the probability or likelihood that a given intervention will help a particular patient. These decisions and others represent the basis of clinical decision-making. Competency with clinical decision-making is the basis for effective patient outcomes and attainment of goals.

Therefore, clinical decision-making can be thought of as the process of using information, experience, and judgments to decide which clinical interventions will most likely improve the problems identified in the examination. The bottom line is this: When identifying and establishing an intervention plan, the focus should be on selecting interventions that will most likely achieve positive results or outcomes—both quantitative and qualitative. When judiciously selected and applied, therapeutic modalities may play a significant role in successful patient care.