- Email: [email protected]
Decreasing Power of Longwave Ultrasound
392
letters Research or Audit? MADAM - The article ‘Does taking students increase waiting lists?’ (Holland, 1997) raises an imponant research question which is highly relevant in the present climate of the shortage of clinical placements for students. It is a question that needs to be answered using structured research methods, but there appears to be some confusion in the project design between the use of research and audit. Research should strive to establish new knowledge, ie ‘What should we be doing?’ while audit checks ‘Are we doing what we should be doing?’ This may be a very simplistic interpretation, but it is one which gives a different emphasis to the two activities. Audit - whether financial, organisational or clinical - strives to compare everyday practice with pre-stated standards and criteria. The author here describes three factors which were audited without the obvious establishment of standards in these areas. While it is perfectly valid to carry out a pre-audit to establish current performance or a baseline on which standards can be set for future audit purposes, this exercise should also take account of research evidence. This project should clarify the purpose of the data collection in terms of new research evidence or to set audit standards; there is a difference between collecting data for research or audit purposes. Managers have been concerned with the effect of continuing a commitment to physiotherapy students in the light of market forces on contracts for physiotherapy services. This project would need to be extended to compare results from a wider group of clinical educators with their own practice over time and beween clinical educators at different sites, for the results to be generalisable (Muir Gray, 1996). Some recognition of this is given by the author in the concluding statements. When introducing students and qualified members of our profession to the purpose of research and audit
Physiotherapy, July 1997, vol83, no 7
activities, they should be valued for what they are, different but complementary, not synonymous. A research project should be designed to offer an answer to a question or hypothesis, giving results which are wherever possible generalisable. This project appears to cross boundaries of audit and research activities, with neither given the full potential. A research question is posed and the results analysed using research methodologies, but the results are not even generalisable within one physiotherapy department. There is a loo at local practice, as in audit, but without a comparison to standards and criteria. My reason for making these points and bringing these issues to the atten-
tion of the membership is due to a concern that there is enough confusion about the differences between audit and research and it is a pity to see that confusion reinforced. If we wish to see our professional Journal accepted for the high level of research contained within in it, then we must. apply a rigorous process to the peer review of such submissions for publication.
Madeline Simpson MCSP Member of the Clinical Audit
Development Group Chartered Society of Physiotherapy
References Holland, K A (1997). ‘Does taking students increase your waiting lists?’ Physiotherapy, 83,4, 166-1 72. Muir Gray, J A (1996). Evidence Based Healthcare, Churchill Livingstone, Edinburgh.
Decreasing Power of Longwave Ultrasound MADAM - We have noted with some interest the successive reductions made by the manufacturers to the maximum power output of the PhysAssist machine to the present 50 mW/cm2(Phys-Assist Handbook) or 74 mW/cm2(Bradnock and Young, 1997). We believe these changes are positive, with respect to safety in using the device. However, with respect to the energy available in successively deeper levels of tissue, these reductions are surprising. By virtue of the physical properties of longwave ultrasound, the level of energy available at successive depths of tissue is already very low (Robertson and Ward, 1997; Ward and Robertson, 1996). To reduce the total power to overcome the risks of
excessive superficial heating may increase safety, but will further compromise the level of energy available at successive depths of tissue. We note that this problem is not shared by MHz frequency ultrasound.
I
Robertson, V J and Ward, A R (1997). ‘Longwave (45 kHz) ultrasound reviewed and reconsidered’, Physiotherapy,83, 3,
Keep on Writing! Letters to the editor are always welcome. Please keep them short and as factual as possible.
I
I I
Valma J Robertson PhD BAppSc(Phty) BA
Alex R Ward MSc La Trobe University Victoria Australia References Bradnock, €3 and Young, M (1997). ‘Longwave ultrasound’ (letter), Physiotherapy, 83, 6, 324. Phys-AssistHandbook (1997?). Manufactured by Orthosonics Ltd, Bembridge, Ashburton, South Devon, UK.
123-1 30.
Ward, A R and Robertson, V J (1996). ‘Comparison of heating of non-living soft tissue produced by 45 kHz and 1 MHz frequency ultrasound machines’, Journal of Orthopaedic and Sports Physical Therapy, 23,4,258-266.
letters Research or Audit? MADAM - The article ‘Does taking students increase waiting lists?’ (Holland, 1997) raises an imponant research question which is highly relevant in the present climate of the shortage of clinical placements for students. It is a question that needs to be answered using structured research methods, but there appears to be some confusion in the project design between the use of research and audit. Research should strive to establish new knowledge, ie ‘What should we be doing?’ while audit checks ‘Are we doing what we should be doing?’ This may be a very simplistic interpretation, but it is one which gives a different emphasis to the two activities. Audit - whether financial, organisational or clinical - strives to compare everyday practice with pre-stated standards and criteria. The author here describes three factors which were audited without the obvious establishment of standards in these areas. While it is perfectly valid to carry out a pre-audit to establish current performance or a baseline on which standards can be set for future audit purposes, this exercise should also take account of research evidence. This project should clarify the purpose of the data collection in terms of new research evidence or to set audit standards; there is a difference between collecting data for research or audit purposes. Managers have been concerned with the effect of continuing a commitment to physiotherapy students in the light of market forces on contracts for physiotherapy services. This project would need to be extended to compare results from a wider group of clinical educators with their own practice over time and beween clinical educators at different sites, for the results to be generalisable (Muir Gray, 1996). Some recognition of this is given by the author in the concluding statements. When introducing students and qualified members of our profession to the purpose of research and audit
Physiotherapy, July 1997, vol83, no 7
activities, they should be valued for what they are, different but complementary, not synonymous. A research project should be designed to offer an answer to a question or hypothesis, giving results which are wherever possible generalisable. This project appears to cross boundaries of audit and research activities, with neither given the full potential. A research question is posed and the results analysed using research methodologies, but the results are not even generalisable within one physiotherapy department. There is a loo at local practice, as in audit, but without a comparison to standards and criteria. My reason for making these points and bringing these issues to the atten-
tion of the membership is due to a concern that there is enough confusion about the differences between audit and research and it is a pity to see that confusion reinforced. If we wish to see our professional Journal accepted for the high level of research contained within in it, then we must. apply a rigorous process to the peer review of such submissions for publication.
Madeline Simpson MCSP Member of the Clinical Audit
Development Group Chartered Society of Physiotherapy
References Holland, K A (1997). ‘Does taking students increase your waiting lists?’ Physiotherapy, 83,4, 166-1 72. Muir Gray, J A (1996). Evidence Based Healthcare, Churchill Livingstone, Edinburgh.
Decreasing Power of Longwave Ultrasound MADAM - We have noted with some interest the successive reductions made by the manufacturers to the maximum power output of the PhysAssist machine to the present 50 mW/cm2(Phys-Assist Handbook) or 74 mW/cm2(Bradnock and Young, 1997). We believe these changes are positive, with respect to safety in using the device. However, with respect to the energy available in successively deeper levels of tissue, these reductions are surprising. By virtue of the physical properties of longwave ultrasound, the level of energy available at successive depths of tissue is already very low (Robertson and Ward, 1997; Ward and Robertson, 1996). To reduce the total power to overcome the risks of
excessive superficial heating may increase safety, but will further compromise the level of energy available at successive depths of tissue. We note that this problem is not shared by MHz frequency ultrasound.
I
Robertson, V J and Ward, A R (1997). ‘Longwave (45 kHz) ultrasound reviewed and reconsidered’, Physiotherapy,83, 3,
Keep on Writing! Letters to the editor are always welcome. Please keep them short and as factual as possible.
I
I I
Valma J Robertson PhD BAppSc(Phty) BA
Alex R Ward MSc La Trobe University Victoria Australia References Bradnock, €3 and Young, M (1997). ‘Longwave ultrasound’ (letter), Physiotherapy, 83, 6, 324. Phys-AssistHandbook (1997?). Manufactured by Orthosonics Ltd, Bembridge, Ashburton, South Devon, UK.
123-1 30.
Ward, A R and Robertson, V J (1996). ‘Comparison of heating of non-living soft tissue produced by 45 kHz and 1 MHz frequency ultrasound machines’, Journal of Orthopaedic and Sports Physical Therapy, 23,4,258-266.