điện thông qua kim để tạo ra các tín hiệu sinh lý cho phép để chữa bệnh phản ứng xảy ra. Một số nghiên cứu đã chỉ ra phản ứng đau thay đổi, nhưng cơ chế mà theo đó châm cứu được cho là ảnh hưởng đến các loại hình chữa bệnh và đáp ứng đau trong cơ thể vẫn còn chưa rõ ràng | 23. The Effect of Therapeutic Modalities on Tendinopathy 239 electrically through needles to induce biophysical signals that allow for healing responses to occur. Some controlled studies have indicated altered pain responses but the mechanism by which acupuncture is believed to affect different types of healing and pain response in the body remains unclear 37 . Evidence-Based Medicine and Therapeutic Modality Use As in other areas of medicine the rehabilitation sciences are rapidly evolving through advanced clinical trials and the trend towards evidence based practice. The randomized controlled trial RCT is currently the gold standard for evaluating the significance of an intervention and its relative importance along a critical pathway. The best available evidence is typically analyzed using one of four types of guidelines expert consensus outcome based meta-analysis and cost-effectiveness and a combination of patient preference and evidence based 38 . Clinicians must demonstrate the effectiveness of their interventions using these guidelines and then correlate their findings with patient responses to pain and dysfunction. This approach has fostered controversy among many rehabilitation specialists as long held beliefs concerning the use of physical modalities in treating soft tissue injuries are coming into question. In October 2001 an independent group of medical professionals therapists and researchers collectively known as the Philadelphia Panel released their findings based on a comprehensive review of the interventions used to treat various musculoskeletal conditions in the neck shoulder low back and knee 39 40 . Randomized controlled cohort case control and nonrandomized studies were collected and statistically analyzed utilizing the MEDLINE EMBASE Current Contents Cochrane Controlled Trial Register and CINAHL databases. The goal of this panel was to establish evidence-based treatment parameters regarding the use of exercise traction manual therapy heat and
