Contra-indications to shortwave diathermy: survey of Irish physiotherapists

Physiotherapists' Understanding of Shortwave Diathermy Contraindications: A Questionnaire Survey

Purpose

It is known that electromagnetic fields and heat generated by shortwave diathermy (SWD) can have adverse effects on living tissue. The purpose of this research is to evaluate Jordanian physiotherapists' knowledge of pulsed and continuous SWD contraindications. And investigate the potential contraindications about which Jordanian physiotherapists may have limited knowledge.

Subjects and Methods

This cross-sectional study investigates Jordanian physiotherapists' knowledge of SWD contraindications. In 38 private and public hospitals, a self-administered questionnaire survey was carried out. Participants were asked to classify 32 conditions as "always, sometime, or never" contraindicated or "I do not know". Participants are physiotherapists with two or more years of postgraduate experience. Two forms comprised the survey. The first consisted of assessing their reaction to the contraindications of pulsed shortwave diathermy (PSWD), while the second consisted of continuous shortwave diathermy (CSWD).

Results

Approximately 270 physiotherapists were eligible to participate in this investigation. Only 150 questionnaires were distributed to the therapists who agreed to the study. One hundred twenty-eight were returned for an average response rate of 85.3% (128/150). Respondents had good agreement about using SWD for cardiovascular condition, however, 24 respondents (19%) thought PSWD can be used over venous thrombosis. Only 64% of the respondents was aware that pacemakers are contraindicated for PSWD. Approximately 14% to 32% seem unaware that tuberculosis and osteomyelitis are contraindicated for both CSWD and PSWD. About 21% to 28% have been unaware that the use of PSWD is contraindicated for specialized tissues (eg, eyes, gonads, or malignant tissues) and 29% during pregnancy.

Conclusion

Jordanian physiotherapists generally agreed on the widely acknowledged contraindications of CSWD for specific conditions. However, there was considerable uncertainty among Jordanian physical therapists about the contraindications of PSWD. This discrepancy highlights the need to improve physiotherapist awareness and for more fact-based research to the contraindication of SWD modality.

Investigation of practices and procedures in the use of therapeutic diathermy: a study from the physiotherapists' health and safety perspective

BACKGROUND AND PURPOSE

The safe use of therapeutic diathermy requires practices and procedures that ensure compliance to professional guidelines and clinical evidence. Inappropriate use may expose physiotherapists and other people in the vicinity of operating diathermy devices to stray radiofrequency electromagnetic fields, which can be a source of risk and may lead to adverse health effects. The aim of the present study was to investigate practices and procedures for therapeutic diathermy from a health and safety perspective.

METHOD

A cross-sectional research design was used, this included a postal survey using a self-administered questionnaire and semi-structured observational visits to 46 physiotherapy departments in National Health Service (NHS) hospitals located in the south-east and south-west of England, including Greater London.

RESULTS

Microwave diathermy was not available in the departments surveyed. Pulsed shortwave diathermy was available and was used more commonly than continuous shortwave diathermy. There were metallic objects in treatment cubicles used for pulsed shortwave diathermy and continuous shortwave diathermy. Shortwave diathermy devices created electromagnetic interference with a variety of electrical and medical devices. Physiotherapists reported that they did not stay in the treatment cubicle during the entire period of electrotherapy with pulsed shortwave diathermy or continous shortwave diathermy; pregnant physiotherapists reported that they did not use these devices. Electrotherapy with pulsed shortwave diathermy and continuous shortwave diathermy was not always administered on a wooden couch or chair. Electrotherapy was highest in those departments with the fewest physiotherapists.

CONCLUSIONS

Departments report good practices and procedures regarding the use of therapeutic diathermy devices. However, field observations of practices and procedures, and the working environment, have identified issues with a potential to create health and safety problems, and these should be addressed.

Use of pulsed shortwave diathermy and joint mobilization to increase ankle range of motion in the presence of surgical implanted metal: A case series

STUDY DESIGN

Case series.

BACKGROUND

Traditionally, all forms of diathermy have been contraindicated over metal implants. There is a lack of research-based evidence for harm regarding the use of pulsed shortwave diathermy (PSWD) over orthopedic metal implants. Because PSWD is an effective modality for deep heating, we investigated whether ankle range of motion (ROM) could improve with the cautious use of PSWD and joint mobilizations, despite orthopedic metal implants being in the treatment field.

CASE DESCRIPTIONS

Four subjects presented with decreased ankle ROM due to extensive fractures from traumatic injuries. All subjects were postsurgical, with several internal fixation devices. Subjects previously received rehabilitation therapy involving joint mobilizations, therapeutic exercises, moist heat, and ice, but continued to lack 15 degrees to 23 degrees of ankle dorsiflexion. The Human Subjects Review Board of Brigham Young University approved the methods of this case series. Subjects gave written informed consent. Initial dorsiflexion active ROM for each patient was -3 degrees, 0 degrees, 8 degrees, and 5 degrees, respectively. Treatment regime consisted of PSWD to the ankle for 20 minutes at 27.12 MHz, 800 pps, 400 microseconds (48 W). Immediately after PSWD, mobilizations were administered to the joints of the ankle and foot. Ice was applied posttreatment.

OUTCOMES

Dorsiflexion improved 15 degrees, 15 degrees, 10 degrees, and 14 degrees, respectively, after 8 or 13 visits. All patients returned to normal activities with functional ROM in all planes. Follow-up 4 to 6 weeks later indicated that the subjects maintained 78% to 100% of their dorsiflexion. No discomfort, pain, or burning was reported during or after treatment. No negative effects were reported during the short-term follow-up.

DISCUSSION

When applied with appropriate caution, we propose PSWD (48 W) may be an appropriate adjunct to joint mobilizations to increase ROM in peripheral joints, despite implanted metal. We continue to advise caution when applying diathermy with machines other than the Megapulse II. Further research is needed to determine the safety parameters of other diathermy machines. As a final caution, we advise that diathermy not be used in the presence of a cardiac pacemaker or neurostimulator.