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Intervention Review

Electromagnetic fields for the treatment of osteoarthritis

  1. Jennifer M Hulme1,*,
  2. Vivian Welch2,
  3. Rob de Bie3,
  4. Maria Judd4,
  5. Peter Tugwell2

Editorial Group: Cochrane Musculoskeletal Group

Published Online: 21 JAN 2002

Assessed as up-to-date: 17 OCT 2001

DOI: 10.1002/14651858.CD003523


How to Cite

Hulme JM, Welch V, de Bie R, Judd M, Tugwell P. Electromagnetic fields for the treatment of osteoarthritis. Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No.: CD003523. DOI: 10.1002/14651858.CD003523.

Author Information

  1. 1

    Toronto, Ontario, Canada

  2. 2

    University of Ottawa, Centre for Global Health, Institute of Population Health, Ottawa, Ontario, Canada

  3. 3

    Maastricht University, Department of Epidemiology, Maastricht, Netherlands

  4. 4

    Canadian Health Services Research Foundation/Fondation canadienne de la recherche sur les services de santé, Research Use/Agente principale de programme, Utilisation de la Recherche, Ottawa, Ontario, Canada

*Jennifer M Hulme, 412 Southway Ave, Toronto, Ontario, Canada. jhulme@jhsph.edu.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2002

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

As the focus for osteoarthritis (OA) treatment shifts away from drug therapy, we consider the effectiveness of pulsed electric stimulation which is proven to stimulate cartilage growth on the cellular level.

Objectives

1)To assess the effectiveness of pulsed electric stimulation for the treatment of osteoarthritis (OA). 2) To assess the most effective and efficient method of applying an electromagnetic field, through pulsed electromagnetic fields (PEMF) or electric stimulation, as well as the consideration of length of treatment, dosage, and the frequency of the applications.

Search methods

We searched PREMEDLINE, MEDLINE, HealthSTAR, CINAHL, PEDro, and the Cochrane Controlled Trials Register (CCTR) up to and including 2001. This included searches through the coordinating offices of the trials registries of the Cochrane Field of Physical and Related Therapies and the Cochrane Musculoskeletal Group for further published and unpublished articles. The electronic search was complemented by hand searches and experts in the area.

Selection criteria

Randomized controlled trials and controlled clinical trials that compared PEMF or direct electric stimulation against placebo in patients with OA.

Data collection and analysis

Two reviewers determined the studies to be included in the review based on inclusion and exclusion criteria (JH,VR) and extracted the data using pre-developed extraction forms for the Cochrane Musculoskeletal Group. The methodological quality of the trials was assessed by the same reviewers using a validated scale (Jadad 1996). Osteoarthritis outcome measures were extracted from the publications according to OMERACT guidelines (Bellamy 1997) and additional secondary outcomes considered.

Main results

Only three studies with a total of 259 OA patients were included in the review. Electrical stimulation therapy had a small to moderate effect on outcomes for knee OA, all statistically significant with clinical benefit ranging from 13-23% greater with active treatment than with placebo. Only 2 outcomes for cervical OA were significantly different with PEMF treatment and no clinical benefit can be reported with changes of 12% or less.

Authors' conclusions

Current evidence suggests that electrical stimulation therapy may provide significant improvements for knee OA, but further studies are required to confirm whether the statistically significant results shown in these trials confer to important benefits.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Electrical stimulation to encourage cartilage growth might be able to improve osteoarthritis of the knee, but more research is needed to be certain.

Pulsed electric stimulation as a treatment for osteoarthritis has appeared promising since the stimulation of cartilage growth was recorded at the cellular level; its growing popularity has now called for evaluation of its effectiveness. The literature search and hand searches identified 3 trials with a total of 259 patients. All trials examined knee OA and one also performed a separate evaluation for cervical OA patients. The results of this analysis show improvements in all measurements for knee OA, but their clinical significance from a patient's perspective was questionable. Only two outcomes favoured treatment for cervical OA trial and none were considered clinically important. There were no reported side effects. The reviewers conclude that there is an urgent need for further large-scale studies of pulsed electric stimulation with a focus on knee OA to establish the clinical relevance of treatment.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

電磁場治療退化性關節炎

考慮非藥物性脈衝電磁場刺激軟骨生長治療退化性關節炎的有效性。

目標

1)研究脈衝電磁場治療退化性關節炎的有效性。2)研究脈衝電磁場最有效及有效率的使用方式,pulsed electromagnetic fields (PEMF) or electric stimulation及並考慮時間、劑量、頻率。

搜尋策略

搜尋包括PREMEDLINE, MEDLINE, HealthSTAR, CINAHL, PEDro, and the Cochrane Controlled Trials Register (CCTR) (直到2001年)。Cochrane Field of Physical and Related Therapies and the Cochrane Musculoskeletal Group,同時手動搜尋所選文章之參考文獻及徵詢專家。

選擇標準

含pulsed electromagnetic fields (PEMF) 或電刺激及安慰劑用於治療退化性關節炎之隨機對照試驗及控制對照試驗。

資料收集與分析

兩位作者使用預製表格獨立進行資料摘錄,並對每篇試驗研究的品質評估。結果測量用OMERACT guidelines,並考慮第二結果指標。

主要結論

3篇臨床試驗(259位患者)符合納入標準。電刺激對治療膝退化性關節炎有小到中度效果,比安慰劑好13 – 23% 。頸椎退化性關節炎僅有2指標在PEMF治療有顯著差異,但改變少於12% ,無顯著臨床效益。

作者結論

電刺激對治療膝退化性關節炎有效果,但需進一步研究及證實效果。

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

電刺激可促進軟骨生長,也許能改善膝蓋的退化性關節炎,但需要更多的研究才能確定。脈衝電刺激治療退化性關節炎看似很有前景,因為在細胞層級刺激軟骨生長已有記錄。它的日益普及已經被要求評估其有效性。文獻檢索和人工檢索到三個試驗,總有259例。所有試驗都有研究膝退化性關節炎和一個有多評估頸椎退化性關節炎患者的試驗。這一分析的結果顯示在所有膝蓋退化性關節炎都有測量到改善,但從病人的角度來看其臨床意義是有問題的。只有兩個結果贊成用於治療頸椎退化性關節炎,但沒有一個是臨床上是有重要意義的。沒有副作用被報告。該回顧者認為,迫切需要進一步大規模研究脈衝電刺激在膝退化性關節炎上的臨床治療意義。