Download the supplement (208 p.) - KCE

164 ······· APPENDICES Physiotherapy KCE reports vol. 40
Transcutaneous electrical nerve stimulation (TENS) and ultrasounds (US) are the two electrophysiotherapeutic
modalities the most frequently used by ambulatory physiotherapists. However, the effectiveness of both TENS
and US to treat patients with low back pain has not been demonstrated.
Total knee replacement
The most common treatment modalities applied by Belgian ambulatory physiotherapists to treat patients with
total knee replacement were, from the most prevalent to the least: muscle strengthening, mobilizations, gait
rehabilitation, education of the patient, massage, home exercises, and stretching. The following treatment
modalities are also frequent but to a lesser extent: contracted-relaxed techniques and cryotherapy. The
treatment modalities rarely applied by ambulatory physiotherapists include electrophysiotherapy,
manipulations, EMG biofeedback, and hydrotherapy.
The treatment modalities and the proportion of physiotherapists in our survey treating at least one patient
with total knee replacement are confronted in Table 4.10 with the results of the literature review on evidencebased
therapeutic modalities. Only a small number of evidence was available in the literature relative to the
physiotherapeutic modalities applied in total knee replacement. Overall, weak evidence was only
demonstrated for education of the patient, home exercises, cryotherapy, and electric stimulation, which is the
most frequent electrophysiotherapeutic modality used in ambulatory practice. On the contrary, moderate
evidence was found for the TENS electrotherapeutic modality which seems ineffective in reducing pain
consecutive to total knee replacement.
Hemiplegia / Hemiparesis
The most common treatment modalities applied by Belgian ambulatory physiotherapists to treat patients with
hemiplegia/hemiparesis were, from the most prevalent to the least: mobilizations, gait rehabilitation, muscle
strengthening, balance rehabilitation, stretching, education of the patient, and functional rehabilitation (i.e.,
activities of daily life (ADL)). Numerous specific movement therapies have been developed: Bobath (normal
movement approach), Kabat (PNF = proprioceptive neuro factilitation), Johnstone, PeRFTtti, Picard, and
Brunnström techniques. Among these specific movement therapies, Bobath and Kabat were the techniques the
most applied in Belgian ambulatory physiotherapy.