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book review __ -

TENS: Clinical Applications and Related Theory by Deirdre M Walsh. Churchill Livingstone, Edinburgh, clinical evidence and applications 1996 (ISBN 0 443 05323 5). Illus. 167 pages. f23.50. (chapters 6 and 7), followed by

chapters dealing with additional This text, written by an established by students, clinicians, lecturers uses for which TENS is effective but expert in her field, sets out to and researchers both within physio-

answer many of the frequently therapy and in related disciplines. less (chapter 8, and the future of TENS (chapter 9). posed questions about transcuta- Without being patronising, the

The final chapter reviews a range neous electrical nerve stimulation author enables readers who follow of current TENS systems and acces- (TENS). By taking a logical, progres- the text through from introduction sories. Although this will become sive and comprehensive approach to specialist chapters to gain know- outdated, it provides a useful review t o the subject, the primary aim is ledge which will inform and improve of the current situation. achieved and more besides. practice.

Diagrams, tables and photo- The author notes that more than For those who require a reference graphs are used to maximal effect 80% of chartered physiotherapists text for a department or practice, it throughout the text, and the print surveyed were dissatisfied with the is well enough organised to allow quality is excellent. amount of information available single chapters or sections t o be

The early chapters which provide t o them. There is undoubtedly, read in isolation without loss of the background information include therefore, an established need continuity or meaning. the historical developments associ- for a modern and comprehensive The main areas covered include ated with TENS and an excellent resource of this nature. the introductory and background chapter which reviews the current The text is eminently readable, information (chapters 1 to 4), ex- physiological concept of pain mod- and its content will be appreciated perimental evidence (chapter 5), ulation. This would constitute a useful review for any therapists working with patients in pain, whether they plan to use TENS or any other modality.

The background information continues with two chapters consid- ering TENS stimulation parameters (in general terms) and the basic electronic principles (the latter by E McAdams). These are areas which are frequently misunder- stood by therapists (and others), and the information is presented in an easily digested format which should help to demystify the subject.

The following chapters are concerned with the experimental and clinical studies associated with the modality. Considerable effort has been made to ensure that quality evidence is included, and any therapist who is in need of a ready source of current reference material would be well advised to use this summary as a starting point.

The author is well versed with the literature, and has evaluated its worth very carefully. Clearly, the body of evidence will change as more laboratory and clinical studies are published, but the current situation is clearly expounded. Each of these two chapters usefully includes information which relates

Cerebral cortex

Components of the ascending nociceptive pathways leading to the pain experience which may be alleviated by TENS

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to appropriate research designs and shortcomings. For those consider- ing research including TENS, this is an essential read.

The clinical application of TENS (chapter 7) focuses quite realisti- cally on the problems for which the modality is most commonly used. Clinicians will find in here a wide range of relevant information which includes the selection of treatment parameters, electrode placement, indications and contra-indications. This chapter alone makes the text

valuable, but is best considered alongside the other components of the book, thus providing rationale for the recipe.

Several interesting (but less commonly utilised) TENS applica- tions are reviewed in chapter 8 which concentrates primarily on the use of TENS for its non-analgesic effects. Although often considered as a means to achieve pain relief, there are numerous other well documented applications, and these are usefully considered.

Dr Walsh is to be congratulated on producing a carefully researched and referenced seminal text in her specialist area, yet making it acces- sible to non-specialist readers. I am happy to recommend it to all who have cause to use TENS, for those who want to learn about it for the first time, and for all who are planning an investigation which includes the modality.

Tim Watson PhD BSc MCSP

Data Collection and Analysis edited by Roger Sapsford and Victor Jupp. Published for the Open University by Sage Publications, London, 1996 (ISBN 0 7619 5046 X). Illus. 360 pages. €15.99. The title of this book is deceptive. It would have been more appropri- ately named Research in the Social Sciences with Emphasis on Data Collection and Analysis. Part 1 (54 pages) deals with research design issues concerned with preparation of a research project. Part 2 (96 pages) is concerned with data collec- tion, and part 3 (165 pages) covers the principal areas of data analysis in the social and political sciences. Part 4 (26 pages) is entitled ‘Con- clusion’ and centres on ethics and politics in research.

The 12 contributors are all drawn from the sociaUpoliticaUeducationa1 sciences and this has contributed to the strong bias throughout the book.

Part 1 is really an introduction to some of the concepts which must be appreciated before embarking on a research project. It is too brief and superficial to be of much value to beginners in research and especially so for undergraduate physiotherapy students, since the contents are so biased towards the social sciences. Research examples include police statistics on crime, children with

Booklore Books reviewed on these pages are not available directly from the Chartered Society of Physio- therapy.

They should be obtainable through good booksellers, or by contacting the publishers given at the top of each review.

learning difficulties, and traffic fatalities.

The one example of a controlled experiment is appalling. It involves experimental and control groups, each with ten depressed subjects. The experimental group enjoyed lectures, discussions, activities and homework. The women in the control condition received no inter- vention and were asked to refrain from joining other therapy groups or seeking counselling. They were effectively ignored.

I found no reference to placebo effect in any part of the book, in spite of the vast amount of litera- ture on the subject, although some of the contributors do refer to sub- ject expectations in the research environment.

Part 2 is a detailed account of modern techniques of data collec- tion. The topics covered include observational research, quest- ionnaires, sources of statistical information and databases. The use of modern technology is included, such as a n automatic observer keyboard-cassette recorder-comp- uter disc link-up.

An example is given of data collection where the observer and recording device are concealed. A periscope was used in three-urinal men’s toilet. (See page 88 for further details.) The sources of information available to social scientists are conveniently given in a list of CD- ROM databases.

Part 3 is extensive and serves as an introduction to statistics. The usual statistical tests encountered

at a n early stage in research are clearly presented and easy to follow, as is the section on presentation of data. The important phenomenon of interaction between independent variables is considered. Page 262 states: ‘Few research problems are so neatly circumscribed that we can identify and test a single cause or influence.’ This is so t rue in the social and clinical settings in which social and health scientists operate.

Part 4 starts by discussing ‘lack of harm’ to subjects, confidentiality and informed consent, It then develops into a sermon on the wicked uses of the outcomes of research by politicians. I am not sure what is implied by the phrase ‘institutionalised behaviour of the police and the criminal justice system’ (page 322). I suspect tha t the authors would say that the fact tha t I picked out this phrase tells them something about me!

In summary, this book is not to be recommended as an undergraduate text for physiotherapy students. I t does not cover ways of allowing for placebo effect, experimenter bias or subject response set by blind and double-blind controls, so necessary in clinical trials. It could be useful for postgraduate physiotherapists working in the community who wish to pursue research in their area of activity.

The book, is however, a n ideal and thought-provoking text for re- searchers in the social sciences. The chapters are interspersed with activity sessions where readers are invited to resolve certain issues which are then discussed in the text. The book is well referenced throughout.

David A Hill MSc BSc MCSP DipTP

Physiotherapy, October 1998, vol84, no 10