Therapeutic ultrasound for osteoarthritis of the knee or hip

 

Abstract

Background

Osteoarthritis is the most common form of joint disease and the leading cause of pain and physical disability in the elderly. Therapeutic ultrasound is one of several physical therapy modalities suggested for the management of pain and loss of function due to osteoarthritis (OA).

Objectives

To compare therapeutic ultrasound with sham or no specific intervention in terms of effects on pain and function safety outcomes in patients with knee or hip OA.

Search methods

We updated the search in CENTRAL, CINAHL, EMBASE, MEDLINE and PEDro up to 23 July 2009, checked conference proceedings, reference lists, and contacted authors.

Selection criteria

Studies were included if they were randomised or quasi-randomised controlled trials that compared therapeutic ultrasound with a sham intervention or no intervention in patients with osteoarthritis of the knee or hip.

Data collection and analysis

Two independent review authors extracted data using standardized forms. Investigators were contacted to obtain missing outcome information. Standardised mean differences (SMDs) were calculated for pain and function, relative risks for safety outcomes. Trials were combined using inverse-variance random-effects meta-analysis.

Main results

Compared to the previous version of the review, four additional trials were identified resulting in the inclusion of five small sized trials in a total of 341 patients with knee OA. No trial included patients with hip OA. Two evaluated pulsed ultrasound, two continuous and one evaluated both pulsed and continuous ultrasound as the active treatment. The methodological quality and the quality of reporting was poor and a high degree of heterogeneity among the trials was revealed for function (88%). For pain, there was an effect in favour of ultrasound therapy, which corresponded to a difference in pain scores between ultrasound and control of -1.2 cm on a 10-cm VAS (95% CI -1.9 to -0.6 cm). For function, we found a trend in favour of ultrasound, which corresponded to a difference in function scores of -1.3 units on a standardised WOMAC disability scale ranging from 0 to 10 (95% CI -3.0 to 0.3). Safety was evaluated in two trials including up to 136 patients; no adverse event, serious adverse event or withdrawals due to adverse events occurred in either trial.

Authors' conclusions

In contrast to the previous version of this review, our results suggest that therapeutic ultrasound may be beneficial for patients with osteoarthritis of the knee. Because of the low quality of the evidence, we are uncertain about the magnitude of the effects on pain relief and function, however. Therapeutic ultrasound is widely used for its potential benefits on both knee pain and function, which may be clinically relevant. Appropriately designed trials of adequate power are therefore warranted.

 

Plain language summary

Therapeutic ultrasound for osteoarthritis

This summary of a Cochrane review presents what we know from research about the effect of therapeutic ultrasound on knee or hip osteoarthritis. The previous version of this review concluded that therapeutic ultrasound had no benefit over fake therapeutic ultrasound in pain relief and functional status.

The updated review shows that in people with osteoarthritis,
-Therapeutic ultrasound may be beneficial for people with osteoarthritis of the knee.

-Therapeutic ultrasound may improve your physical function but this finding could be the result of chance.

- We are uncertain about the magnitude of effects on pain relief or the ability to use your knee, because of the low quality of the evidence.
-Therapeutic ultrasound may not have any side effects: no side effects were reported, but we do not have precise information about side effects. This is particularly true for rare but serious side effects. 

There are no studies that address the benefits of therapeutic ultrasound in people with hip osteoarthritis.

What is osteoarthritis and what is therapeutic ultrasound?

Osteoarthritis is a disease of the joints, such as your knee or hip. When the joint loses cartilage, the bone grows to try and repair the damage. Instead of making things better, however, the bone grows abnormally and makes things worse. For example, the bone can become misshapen and make the joint painful and unstable.  This can affect your physical function or ability to use your knee.
Therapeutic ultrasound means using sound waves to try and relieve pain or disability. Your doctor or physiotherapist will use a round-headed wand or probe on the skin of the painful area. Ultrasound gel is used on the wand and on your skin to make it more comfortable and help the sound waves reach the affected area. 

Best estimate of what happens to people with osteoarthritis who have had therapeutic ultrasound for a duration of 2-8 weeks:

Pain
-People who used therapeutic ultrasound had an improvement in their pain of about 3 on a scale from 0 (no pain) to 10 (extreme pain) after using it up to 2 months.
-People who used a fake therapeutic ultrasound had an improvement in their pain of about 2 on a scale from 0 to 10 after using it up to 2 months.
Another way of saying this is:
- 37 people out of 100 who use therapeutic ultrasound respond to treatment (37%).
- 31 people out of 100 who use fake therapeutic ultrasound respond to treatment (31%).
- 6 more people respond to treatment with therapeutic ultrasound than with fake therapeutic ultrasound (difference of 6%).

 

摘要

背景

治療性超音波治療退化性關節炎

治療性超音波是治療退化性關節炎疼痛及失能之許多物理治療之一。

目標

研究治療性超音波治療退化性關節炎疼痛之效果。

搜尋策略

搜尋包括Cochrane Musculoskeletal Group register and MEDLINE (直到2000年12月)，同時搜尋所選文章之參考文獻及聯絡專家。

選擇標準

所有比較治療性超音波與安慰劑或其他治療退化性關節炎之隨機對照試驗研究、對照試驗研究。

資料收集與分析

兩位作者獨立進行資料摘錄，並評估摘錄資料的品質。針對關節數、疼痛、整體及功能評估，計算加權平均差異(weighted mean difference, WMD)。本文使用卡方檢定各試驗間異質性，並用固定效應模型(fixedeffects model)分析，若有異質性，則用隨機效應模型(randomeffects model)分析。

主要結論

3篇臨床試驗(294位髖或膝退化性關節炎患者)符合納入標準。1篇(74位患者)比較治療性超音波4週與安慰劑，對關節活動度、疼痛、或走動速度兩組無顯著差異。2篇(220位患者)比較治療性超音波4週與其他治療賈法尼電流或短波透熱療法，對關節疼痛、患者改善評估兩組無顯著差異。

作者結論

治療性超音波治療退化性關節炎之效果與安慰劑或短波透熱療法對髖或膝退化性關節炎患者可能有效果但因論文品質與設計不良，故無法有最鐘結論。本文結論因研究品質、族群、退化性關節炎嚴重度分期等許多因素而受限制。

翻譯人

本摘要由林口長庚醫院余光輝翻譯。

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

總結

治療性超音波治療退化性關節炎：Cochrane review 此概要讓我們知道治療性超音波治療膝蓋/髖部退化性關節炎的效果。以前的review版本結論是治療性超音波與假治療性超音波相比，緩解疼痛和功能狀態並沒有好處。更新後的review表明，治療性超音波對膝蓋退化性關節炎患者可能是有益的。治療性超音波可以改善你的身體功能，但這個發現可能是機率的結果。因為低品質的證據，我們不確定對緩解疼痛效果的強度，跟使用你的膝蓋的能力。治療性超音波可能沒有任何副作用：無副作用的報導，但我們沒有確切的有關副作用資訊。這確實是正確的有罕見但嚴重的副作用。沒有研究報導治療性超音波治療髖部退化性關節炎的好處。什麼是退化性關節炎，什麼是治療性超音波？退化性關節炎是一種關節疾病，如你的膝蓋或髖部。當關節失去軟骨，骨頭會生長試圖修復損壞。但這不是讓狀況更好，反而骨生長異常會使事情變得更糟。例如，骨變得畸形，使關節疼痛和不穩定的。這會影響你的身體功能或使用你的膝蓋的能力。超音波治療是指利用聲波來減輕疼痛或殘疾。你的醫生或物理治療師將使用圓頭棒或探頭接觸在疼痛區域的皮膚上。超音波凝膠塗在探頭接觸在你的皮膚上，使之更加舒適，並幫助聲波到達影響區域。最樂觀估計，有退化性關節炎患者使用治療性超音波會發生效果約要2 – 8個星期。疼痛：使用治療性超音波之後的2個月, 使病人有改善他們的疼痛約 3(量表規模 0(無疼痛)到10 (極度疼痛)。)