Commentary on the Use of Electrophysical Agents in Physical Therapy

October is National Physical Therapy Month

In the practice of physical therapy, biophysical agents (BPAs) or electrophysical agents (EPAs) are often used in the treatment of patients with various diagnoses and impairments, including acute and chronic pain, weakness, limited range of motion, incoordination, and wounds. Physical therapists learn to use evidence-based BPAs/EPAs in school, are tested on knowledge related to use on their licensure exam, and many have seen countless examples of the effectiveness applying these interventions in practice. Despite all of this we come across resistance and at times condemnation of their use on several fronts.

In an October 2023 article, On Putting an End to the Backlash Against Electrophysical Agents, in the International Journal of Sports Physical Therapy, Belanger et al. provided commentary to expose the inaccuracy of statements against EPAs in the media and emphasize the need for the American Physical Therapy Association (APTA), the Commission on Accreditation in Physical Therapy (CAPTE), and the Federation of State Boards of Physical Therapy (FSBPT) organizations to renew their position supporting EPAs.

• The APTA’s Guide to Physical Therapist Practice 4.0 lists EPAs as interventions.
• CAPTE mandates that all physiotherapy schools include EPAs in their curricula.
• FSBPT tests students on EPAs during licensure exam.

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1. “There is little to no research-based evidence.”  WRONG

• There is actually significant research available for clinicians supporting the use of EPAs, including many randomized controlled trials, systematic reviews, and meta-analyses. In the article, Making the Case for Modalities (Page, 2021), the author found 220,000 papers on electrotherapy and ultrasound, compared to only 160,000 on therapeutic exercise and 26,000 on manual therapy.

• EPAs demonstrate efficacy for many conditions, including:
  • Transcutaneous electrical nerve stimulation (TENS) for pain.
  • Neuromuscular electrical stimulation (NMES) for quadriceps function following knee reconstruction.
  • Electrical stimulation for tissue healing in wound management.

2. “The body of research-based evidence is of poor quality.” INVALID

• In fact, the scientific peer-reviewed literature shows that the research articles for EPAs are not of lower quality than any other areas of physical therapy.

3. “Passive delivery nature of EPAs may be harmful to patients.” UNTRUE

• This would mean that other passive interventions like manual therapy, use of medications, and surgical procedures may similarly be classified as harmful. Patients should be provided appropriate, necessary, and properly timed interventions based on specific patient needs regardless of the active/passive nature.
• The method of intervention delivery (active or passive) has nothing to do with resulting harm or benefit. Instead, it has to do with the clinician’s responsibility to provide instruction to maximize the interventions benefit for the patient.

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Physical therapy organizations in other countries around the world do not have these same adverse reactions to the use of EPAs. Belanger et al. propose a call to action by the APTA, CAPTE, and FSBPT to reconfirm their position on supporting the use of EPAs, as well as urge physical therapists to report grievances regarding inappropriate EPA use to their state licensing board.

Author:
Andreé Akst, PT, MPT, CEEAA, NASM-CES, Clinical Services Content Specialist