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Introduction
The American Occupational Therapy Association (AOTA) asserts that physical agents and mechanical modalities (PAMs) may be used by occupational therapy practitioners1 as part of a comprehensive plan of intervention designed to enhance engagement in occupation (AOTA, 2014b). Occupational therapy practitioners possess the foundational knowledge of basic sciences, understanding of relevant theory and evidence, and clinical reasoning to recommend and safely apply PAMs to support achievement of client goals.
This Position Paper clarifies the context for the appropriate use of PAMs in contemporary occupation-based occupational therapy practice. As guided by the Occupational Therapy Practice Framework: Domain and Process, 3rd Edition (OTPF-3; AOTA, 2014b), exclusive or stand-alone use of PAMs without linking it to a client-centered, occupation-based intervention plan and outcomes is not occupational therapy. Consistent with the Choosing Wisely initiative, AOTA supports that practitioners "don't use PAMs without providing purposeful and occupation-based intervention activities" (Gillen, Hunter, Lieberman, & Stutzbach, in press).
Definitions
The term therapeutic modalities refers to the systematic application of various forms of energy or force to effect therapeutic change in the physiology of tissues. Physical agents such as heat, cold, water, light, sound, and electricity may be applied to the body to affect client factors, including the neurophysiologic, musculoskeletal, integumentary, circulatory, or metabolic functions of the body. Physical agents may be used to reduce or modulate pain, reduce inflammation, increase tissue extensibility and range of motion, promote circulation, decrease edema, facilitate healing, stimulate muscle activity, and facilitate occupational performance (Bracciano, 2019).
Physical agent modalities may be categorized on the basis of their properties:
1.Thermal-Thermal modalities are those physical agents that provide a change in tissue temperature, either heating or cooling the tissue. Thermal modalities can also be categorized into superficial or thermal agents and deep thermal agents on the basis of the depth of energy penetration into the underlying tissue, body function, or body structure they are targeting. Thermal agents (heat or cold) facilitate transfer of energy through conduction, convection, or conversion.
a. Superficial thermal agents-
i. Conduction-Heat or cold is transferred from an object to the body with direct contact with the modality. Examples include, but are not limited to, hot packs, cold packs, and paraffin.
ii. Convection-Heat or cold is transferred between two objects where one is moving or flowing...