Electrotherapy best practice has evolved, have you?

As physiotherapy practice continues to evolve with emerging evidence, the role of electrotherapeutic modalities has become increasingly refined and targeted. The Physiopedia team are reviewing and updating pages related to electrotherapy, to ensure they reflect current best practice recommendations where exercise therapy, manual therapy and patient education remain the cornerstone of effective treatment, and also help to guide your clinical decision making.

The landscape of electrotherapy in physiotherapy has undergone significant transformation over the years. Where once these modalities were widely applied across numerous conditions, current evidence-based practice demands a more discriminating approach. Major international organisations, including the World Health Organization and World Physiotherapy emphasise that non-physical interventions should form the foundation of physiotherapy treatment plans, and global campaigns advocate for dialogue on avoiding wasteful or unnecessary medical tests, treatments, and procedures which are not backed by recent evidence.

This shift represents a change in our understanding of therapeutic effectiveness thanks to more recent evidence on the topic. Rather than viewing electrotherapy as a routine adjunct to treatment, modern practice requires clinicians to apply these modalities only when robust, condition-specific evidence supports their use. Crucially, electrotherapeutic modalities should be used as an adjunct to physical therapy, not as the sole treatment of a condition. This evidence-based approach ensures patients receive the most effective interventions whilst avoiding unnecessary treatments that may not contribute meaningfully to their recovery. The evolution of electrotherapy practice also reflects broader changes in healthcare delivery, where patient education and engagement are increasingly recognised as central to successful outcomes.

Despite the fact that there has been a bigger shift away from electrotherapy in musculoskeletal rehabilitation with low evidence at best for many of the previously commonly used modalities, there may still be a place for electrotherapy. Whilst evidence exists for the use of functional electric stimulation to improve mobility in adults with lower limb impairment due to an upper motor neuron lesion, and it remains equivocal whether electrical stimulation should be used to improve muscle strength in chronic respiratory conditions, chronic heart failure and chronic kidney disease, some treatments such as extracorporeal shockwave therapy (ESWT) for Achilles tendinopathy have maintained popularity, if not being wholly endorsed by the current evidence.

In any case, clinical recommendations now emphasise avoiding patient dependency on these treatments, which may hamper long-term functional outcomes. Instead, electrotherapy should be positioned to facilitate patient participation in active treatment programmes, helping individuals engage more effectively with exercise therapy and self-management strategies. Modern electrotherapy application must incorporate these elements, with patients understanding not just what treatment they are receiving, but why specific modalities have been selected based on current evidence. This educational component helps prevent over-reliance on passive interventions and promotes active participation in recovery. Patient education becomes particularly important when discussing the role and limitations of electrotherapeutic interventions. Clinicians must communicate clearly that these modalities, whilst potentially beneficial in specific circumstances, represent just one component of a comprehensive treatment approach. This transparency helps establish realistic expectations and encourages patients to engage meaningfully with the active components of their rehabilitation programme.

To support the global rehabilitation community in these aims, this month our Physiopedia volunteers are working hard in the background to make sure that recent evidence is reflected in all our Physiopedia pages about electrotherapy and we need your help! Do you follow any guidelines on electrotherapy in rehabilitation, or have you read recent evidence that sheds light on transcutaneous electrical nerve stimulation (TENS), ultrasound therapy, interferential current or extracorporeal shockwave therapy? We want all our pages to reflect the latest evidence and to clearly outline the specific conditions and circumstances where evidence supports their application (or not) so that you can provide the best treatment and education for your patients. Let us know!

As the evidence base continues to evolve in all therapeutic areas, Physiopedia remains committed to providing up-to-date, evidence-based information that supports excellent patient care worldwide and we welcome contributions from all corners of the globe to help to maintain this free global knowledge resource for everyone.