BACKGROUND: Osteoarthritis is the most common form of joint disease and theleading cause of pain and physical disability in the elderly. Therapeuticultrasound is one of several physical therapy modalities suggested for themanagement of pain and loss of function due to osteoarthritis (OA).OBJECTIVES: To compare therapeutic ultrasound with sham or no specificintervention in terms of effects on pain and function safety outcomes in patientswith knee or hip OA.SEARCH STRATEGY: We updated the search in CENTRAL, CINAHL, EMBASE, MEDLINE andPEDro up to 23 July 2009, checked conference proceedings, reference lists, andcontacted authors.SELECTION CRITERIA: Studies were included if they were randomised orquasi-randomised controlled trials that compared therapeutic ultrasound with asham intervention or no intervention in patients with osteoarthritis of the knee or hip.DATA COLLECTION AND ANALYSIS: Two independent review authors extracted data usingstandardized forms. Investigators were contacted to obtain missing outcomeinformation. Standardised mean differences (SMDs) were calculated for pain andfunction, relative risks for safety outcomes. Trials were combined usinginverse-variance random-effects meta-analysis.MAIN RESULTS: Compared to the previous version of the review, four additionaltrials were identified resulting in the inclusion of five small sized trials in atotal of 341 patients with knee OA. No trial included patients with hip OA. Twoevaluated pulsed ultrasound, two continuous and one evaluated both pulsed andcontinuous ultrasound as the active treatment. The methodological quality and thequality of reporting was poor and a high degree of heterogeneity among the trialswas revealed for function (88%). For pain, there was an effect in favour ofultrasound therapy, which corresponded to a difference in pain scores betweenultrasound and control of -1.2 cm on a 10-cm VAS (95% CI -1.9 to -0.6 cm). Forfunction, we found a trend in favour of ultrasound, which corresponded to adifference in function scores of -1.3 units on a standardised WOMAC disabilityscale ranging from 0 to 10 (95% CI -3.0 to 0.3). Safety was evaluated in twotrials including up to 136 patients; no adverse event, serious adverse event orwithdrawals due to adverse events occurred in either trial.AUTHORS' CONCLUSIONS: In contrast to the previous version of this review, ourresults suggest that therapeutic ultrasound may be beneficial for patients withosteoarthritis of the knee. Because of the low quality of the evidence, we areuncertain about the magnitude of the effects on pain relief and function,however. Therapeutic ultrasound is widely used for its potential benefits on bothknee pain and function, which may be clinically relevant. Appropriately designed trials of adequate power are therefore warranted.
Therapeutic ultrasound for osteoarthritis of the knee or hip
Rutjes, Anne;
2010-01-01
Abstract
BACKGROUND: Osteoarthritis is the most common form of joint disease and theleading cause of pain and physical disability in the elderly. Therapeuticultrasound is one of several physical therapy modalities suggested for themanagement of pain and loss of function due to osteoarthritis (OA).OBJECTIVES: To compare therapeutic ultrasound with sham or no specificintervention in terms of effects on pain and function safety outcomes in patientswith knee or hip OA.SEARCH STRATEGY: We updated the search in CENTRAL, CINAHL, EMBASE, MEDLINE andPEDro up to 23 July 2009, checked conference proceedings, reference lists, andcontacted authors.SELECTION CRITERIA: Studies were included if they were randomised orquasi-randomised controlled trials that compared therapeutic ultrasound with asham intervention or no intervention in patients with osteoarthritis of the knee or hip.DATA COLLECTION AND ANALYSIS: Two independent review authors extracted data usingstandardized forms. Investigators were contacted to obtain missing outcomeinformation. Standardised mean differences (SMDs) were calculated for pain andfunction, relative risks for safety outcomes. Trials were combined usinginverse-variance random-effects meta-analysis.MAIN RESULTS: Compared to the previous version of the review, four additionaltrials were identified resulting in the inclusion of five small sized trials in atotal of 341 patients with knee OA. No trial included patients with hip OA. Twoevaluated pulsed ultrasound, two continuous and one evaluated both pulsed andcontinuous ultrasound as the active treatment. The methodological quality and thequality of reporting was poor and a high degree of heterogeneity among the trialswas revealed for function (88%). For pain, there was an effect in favour ofultrasound therapy, which corresponded to a difference in pain scores betweenultrasound and control of -1.2 cm on a 10-cm VAS (95% CI -1.9 to -0.6 cm). Forfunction, we found a trend in favour of ultrasound, which corresponded to adifference in function scores of -1.3 units on a standardised WOMAC disabilityscale ranging from 0 to 10 (95% CI -3.0 to 0.3). Safety was evaluated in twotrials including up to 136 patients; no adverse event, serious adverse event orwithdrawals due to adverse events occurred in either trial.AUTHORS' CONCLUSIONS: In contrast to the previous version of this review, ourresults suggest that therapeutic ultrasound may be beneficial for patients withosteoarthritis of the knee. Because of the low quality of the evidence, we areuncertain about the magnitude of the effects on pain relief and function,however. Therapeutic ultrasound is widely used for its potential benefits on bothknee pain and function, which may be clinically relevant. Appropriately designed trials of adequate power are therefore warranted.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
