Therapeutic ultrasound for acute ankle sprains

 

Abstract

Background

Ultrasound is used in the treatment of a wide variety of musculoskeletal disorders, which include acute ankle sprains. This is an update of a Cochrane review first published in 1999, and previously updated in 2004.

Objectives

To evaluate the effects of ultrasound therapy in the treatment of acute ankle sprains.

Search methods

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (September 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 3), MEDLINE (1966 to September 2010), EMBASE (1983 to September 2010), CINAHL (1982 to 2004), and PEDro - the Physiotherapy Evidence Database (accessed 01/06/09). We also searched the Cochrane Rehabilitation and Related Therapies Field database, reference lists of articles, and contacted colleagues.The WHO International Clinical Trials Registry Platform was searched for ongoing trials.

Selection criteria

Randomised or quasi-randomised trials were included if the following conditions were met: at least one study group was treated with therapeutic ultrasound; participants had acute lateral ankle sprains; and outcome measures included general improvement, pain, swelling, functional disability, or range of motion.

Data collection and analysis

Two authors independently performed study selection, and assessed the risk of bias and extracted data. Risk ratios and risk differences together with 95% confidence intervals were calculated for dichotomous outcomes and mean differences together with 95% confidence intervals for continuous outcome measures. Limited pooling of data was undertaken where there was clinical homogeneity in terms of participants, treatments, outcomes, and follow-up time points.

Main results

Six trials were included, involving 606 participants. Five trials included comparisons of ultrasound therapy with sham ultrasound; and three trials included single comparisons of ultrasound with three other treatments. The assessment of risk of bias was hampered by poor reporting of trial methods and results. None of the five placebo-controlled trials (sham ultrasound) demonstrated statistically significant differences between true and sham ultrasound therapy for any outcome measure at one to four weeks of follow-up. The pooled risk ratio for general improvement at one week was 1.04 (random-effects model, 95% confidence interval 0.92 to 1.17) for active versus sham ultrasound. The differences between intervention groups were generally small, between zero and six per cent, for most dichotomous outcomes.

Authors' conclusions

The evidence from the five small placebo-controlled trials included in this review does not support the use of ultrasound in the treatment of acute ankle sprains. The potential treatment effects of ultrasound appear to be generally small and of probably of limited clinical importance, especially in the context of the usually short-term recovery period for these injuries. However, the available evidence is insufficient to rule out the possibility that there is an optimal dosage schedule for ultrasound therapy that may be of benefit.

 

Plain language summary

Therapeutic ultrasound for acute ankle sprains

Ultrasound, or the use of high frequency sound pulses, is used for treating acute ankle sprains. It is thought that the increase in temperature caused by ultrasound helps soft tissue healing. The review aimed to look at the evidence from studies testing the use of ultrasound in clinical practice. Six trials were included in the review. Poor reporting of trial methods made it difficult to assess the risk of bias of the included studies. The six trials involved a total of 606 participants with acute ankle sprains of relatively short duration. Five trials compared ultrasound therapy with sham ultrasound (machine turned off). Three of the six trials included single comparisons of ultrasound with three other treatments. The main results were from the review of the five placebo-controlled trials (sham ultrasound). These found that ultrasound therapy does not seem to enhance recovery or help to reduce pain and swelling after an ankle sprain, or improve the ability to stand on the affected foot and ankle. Most ankle sprains heal quickly. While ultrasound may still improve recovery in a small way, this potential benefit is probably too small to be important.

 

摘要

背景

急性足踝扭傷的超音波治療

超音波在肌肉骨骼系統的治療上受到廣泛的應用

目標

評估超音波治療在急性足踝扭傷的效果

搜尋策略

我們找了 Cochrane Musculoskeletal Injuries Group Specialised Register (2004年7月), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2004), MEDLINE (1966年至2004年7月), EMBASE (1983年至2004年7月), CINAHL (1982年至2004年7月), 和PEDro  the Physiotherapy Evidence Database (http://ptwww.cchs.usyd.edu.au/pedro/) (accessed 17/09/04)。我們也找了 Cochrane Rehabilitation and Related Therapies Field database, 文末的 reference lists, 還有接觸過的同仁。

選擇標準

我們選擇有以下條件的隨機性試驗：至少一組病人以活性超音波(active ultrasound)治療；參與者有急性的外踝扭傷；其結果測量標準包括整體進步程度、疼痛程度、腫大程度、功能喪失程度、肢體活動範圍。最後選用的文獻由兩位作者獨立選出。

資料收集與分析

以標準化的項目列表(checklist)，兩位作者獨立評估研究品質，並整理出資料。當測量結果為二位元(dichotomous)時及加權性或使用相異之測量尺度時，我們同時計算relative risks以及95% 信賴區間(confidence intervals)；當測量結果為連續性時，計算標準平均差(standardised mean differences)和95%信賴區間(confidence intervals)。當參與者、治療方法、結果(outcomes)、還有追蹤的時間點有臨床上同質性出現時，資料就被擷取並儲存。

主要結論

這篇文章包含五組試驗，總共572個病人。其中四個試驗具備不太好的品質方法，另一組為安慰劑對照組試驗，具有好的品質。這四組安慰劑對照的試驗中，追蹤7到14天，沒有一個在真超音波與偽超音波之間發現顯著差異。我們收集到真超音波對比偽超音波的整體改善之相對危險性(relative risk)是1.04 (randomeffects model, 95% confidence interval 0.92 to 1.17)。有介入治療的群體一般差異不大，兩組的outcome差異在0% – 6%之間。然而，有一組試驗顯示真超音波在無痛狀態與腫脹上有相對大的差異，分別是20%(無痛狀態)與25%(腫脹)。

作者結論

對於急性足踝扭傷的超音波治療效果，可用的證據上其應用範圍與品質上都是有限的。四組安慰劑對照試驗(trials)的結果，並不支持使用超音波當做治療足踝扭傷的工具。治療的效果通常不顯著而且在臨床應用上也無重要性。然而，我們可得的僅有少數試驗(trials)，而且關於超音波治療的任何理想劑量時程及究竟這樣的時程表能否讓缺少有效性報告的超音波治療之足踝扭傷得以改善，目前為止並沒有結論。

翻譯人

本摘要由臺灣大學附設醫院羅婉育翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

踝扭傷的復原，超音波也許幫不上忙。超音波，或是使用高頻率的音波，經常用來治療急性足踝扭傷。多數人認為利用超音波增高溫度可以幫助組織癒合。這篇回顧(review)發現超音波治療並未減緩疼痛和腫脹，或是改善患肢的站立能力。多數的傷患在兩週內康復，而超音波並不能縮短這個時程。多數試驗不支持使用超音波，原因在於效果上的差異都很小。