Clinical library
Electrophysical Agents and Modalities
What each machine in the department actually does, at what dose, in which condition, and how much of the reported effect survives comparison with the minimal clinically important difference. Several do not.
Statistical significance is not the test these pages apply. A modality that reduces pain by an amount smaller than a patient can notice has produced a result, not a benefit. Where a systematic review reports both the effect and the minimal clinically important difference, these pages report both, in that order.
Dose is treated as part of the intervention rather than a footnote. Two of the pages below have a different conclusion at recommended dose than at pooled dose, which is not a subtlety — it is the difference between a treatment working and not.
Electrical, light and thermal agents
Published now
Electrotherapy and Passive Modalities
The overview page. TENS has 381 randomised trials behind it; traction loses its effect entirely once you restrict to high-quality studies.
Interferential Current
Beats placebo in chronic low back pain and beats TENS by a margin smaller than the measurement error. Adds nothing to massage, exercise or standard care.
Low-Level Laser and Photobiomodulation
The clearest dose-response of any modality here: at recommended doses the knee osteoarthritis effect roughly doubles, and it outlasts the treatment course.
Shortwave Diathermy
A moderate pain effect in knee osteoarthritis with no significant effect on function — and the studies that did not heat tissue did not work.
Cryotherapy
Statistically significant pain reductions after surgery that sit below the minimal clinically important difference, and no benefit in acute ankle sprain.
Superficial Heat
The strongest evidence is not in the joint you expect: heat matched or beat NSAIDs for period pain with a third of the adverse-effect risk.
What is not here. Therapeutic ultrasound, TENS, dry needling, traction and extracorporeal shockwave are not published because they have not yet been written to the standard of the pages above, not because the evidence is missing. They are named so that their absence reads as a gap rather than a judgement.
Using this in clinic
Every figure here is traceable to its source.
Each page reports the effect size, the dose it was achieved at, and the minimal clinically important difference it has to clear. Where a value could not be verified against the paper it came from, it is not on this page, and the omission is stated rather than filled with a number from a secondary source.