“The fact that curricular content given to principles and application of therapeutic modalities has remained pervasive in educational programs within the rehabilitation sciences substantiates the continued contribution of this area of practice to the more encompassing patient management model.”
This quote is firmly embedded within the perspective off ered by Michlovitz, Bellew, and Nolan as an essential aspect of “Therapeutic Modalities as a Curricular Thread”, noted in their instruction on “How to Use This Book” (6th edition). Moreover, the Preface addresses important issues regarding the use of modalities and the value added by taking cherished time to teach content that defines the chapters of this book. So why continue with an emphasis on the teaching and use of modalities, even if this text represents the premier resource status born and nurtured over 6 editions?
To answer this question, I draw upon my own role as an educator who taught human anatomy for over 40 years. The content was sculptured to include the time-honored classroom lecture and laboratory dissection (or pro-section review) of bodies so thoughtfully donated so future rehabilitation or medical students could learn “first-hand.” About 5 years ago and rather abruptly, the course curriculum changed to parallel materials taught in other basic sciences, specifically the creation of problem-based learning. For anatomy, that meant teaching body regions and systems in conjunction with what was being learned in other courses with the mandate that the (anatomical) content be populated with substantial numbers of clinically relevant examples that linked anatomy to both treatment and evidence for its efficacy.
This prescient mandate seemed most timely with the development of personalized (precision) medicine, or in our case, rehabilitation. While there are clear distinctions between definitions underlying personalization and precision, the undeniable fact is that a Pub Med search reveals an exponential growth in publications on Personalized Rehabilitation. The total number of publications in 1990, 2000, 2010, and 2020 were over 4.5, 7.0, 16, and 24.4 thousand, respectively. The primary operational component in this concept has been the specification of each patient’s individual requirements for customized and distinctive comprehensive management. Herein lies the essence of the perspective off ered by Drs. Bellew and Nolan in their Therapeutic Modalities: Attitudes, Acceptance, Opinion, and Reality found adjacent to this Foreword. They emphasize that contemporary use of modalities demands an accountability to substantiate their use. Such validation is best achieved not by the application of any modality approach in isolation, but by demonstrating its use within therapeutic context and relevance to the unique patient signs and symptoms, history, and diagnosis. This specification bears remarkable resemblance to the ongoing transition in teaching anatomy noted above. One cannot teach in isolation; relevance and evidence now define the significance of modality utilization.
These substantive mandates characterize the emphasis and modifications contributing to this seventh edition. A strength of the entire Contemporary Perspectives in Rehabilitation series is the belief that all references are updated and provide the best evidence to support the specific content to which they refer. Adherence to this point of view has been a hallmark of all seven editions and takes on even more importance. The current information on the science and practice of therapeutic interventions is an essential precursor to employing precise treatment. In this context, the contributors have painstakingly off ered step-by-step approaches to the specification of treatment applications for individual conditions. This effort should facilitate easier, comprehensive patient management. These provisions are bolstered further with the provision of new Case Studies, each of which is fortified through active discussions of clinical decision making almost as if an active dialogue was being undertaken. The addition of “For Whom and When” boxes are designed to succinctly define which patients are most appropriate to receive specific physical agents and when their provision is most indicated and by prevailing evidence. This new addition represents a cornerstone of precision care so essential to contemporary practice. “Complementary Role” sections highlight how specific agents help to fortify other interventions as an essential part of total patient management.
Last, the text includes several key features expected by contemporary students and clinicians. For example, “Clinical Controversy” boxes provide varying opinions on appropriate use of modalities. The Case Studies also contain clinical decision components characterized by stated rationales for selection and application of each therapeutic modality. Students might consider pairing these cases with the frequent provision of” Key Word Literature Searches” and “Websites for Literature Evidence” boxes designed to enhance the developing comprehension of research and evidence. Additionally, the inclusion of “Suggested Lab Activities” are designed to stimulate discussion and hands-on practice. Illustrations, photographs, and graphs are specifically offered to familiarize students with necessary equipment they will encounter during clinical rotations. Important facts are highlighted within each chapter so that students are best prepared for tests on clinical applications of each modality.
The 7th edition of Michlovitz’s Modalities for Therapeutic Intervention is truly the premier text for all students and clinicians who are now charged with the responsibility of defining the optimization of their use for specific patients and diagnoses. This emergent perception bolsters not only the importance of therapeutic modalities but provides the essential opportunity to clearly support the justifications for their use.
Steven L. Wolf, PD, PT, FAPTA, FAHA, FASNR
Editor-in-Chief, Contemporary Perspectives in Rehabilitation Series