Background: Interferential current is one of the most common electrotherapeutic modalities used in the treatment of painful conditions. Patients seeking medical help to reduce their musculoskeletal pain can be treated using interferential current. Objective: The current review aimed to analyze the recently available information regarding the efficacy of interferential current in alleviating the pain of musculoskeletal origin. Methods: This study used Scopus, CINAHL, Cochrane Library, Web of Science, MEDLINE, Embase, and EBSCOas as data sources. The initial selection of the studies, thorough assessment of the full articles, and extraction of the necessary study characteristics were carried out by two independent reviewers. Another two independent reviewers assessed the methodological quality of each included trial against 39 criteria. These criteria were integrated from several popular scales. Pain intensity-measured using the visual analog scale, numeric pain rating scale, or McGill Pain Questionnaire-was the outcome of interest. Results: This review included 35 trials of variable methodological quality from which 19 trials were selected for the meta-analysis. In general, interferential current alone versus placebo demonstrated a significant pain-relieving effect. On the other hand, interferential current showed no significant difference when added to standard treatment compared with placebo plus standard treatment or standard treatment alone. Similarly, interferential current showed no significant difference when compared with other single interventions (laser, transcutaneous electrical nerve stimulation, cryotherapy). Conclusions: Interferential current alone is better than placebo at discharge. However, the low number of studies raises suspicions about this conclusion. Interferential current alone or added to other interventions is not more effective than comparative treatments in relieving musculoskeletal pain.
Meta-analyses of randomised controlled trials (RCTs) report that polyphenol-rich diets can modulate a range of cardiometabolic biomarkers, with increasing evidence that inter-individual factors (e.g. age, BMI, or ethnicity) contribute toward the variability in the response to the bioactive (1,2). This systematic review and meta-analysis assessed the effect of flavanols from cocoa, apple and tea on fasting insulin and HOMA-IR and explored the role of inter-individual variability. PubMed and Web of Science databases were searched from inception to October 2017 (PROSPERO reg. CRD42016033878). The effect of flavanols supplementation on insulin and HOMA-IR was estimated using a random effects meta-analysis model and reported as standardised mean difference (SMD) and 95%CI. Subgroup analyses (Q tests; multivariate meta-regression) focused on baseline BMI, gender, age, and geographical location to explore the role of inter-individual variability. Out of 1409 studies identified, 31 RCTs were included for insulin (n = 1792) and 21 RCTs for HOMA-IR (n = 1152). Low heterogeneity was found between studies (insulin I 2 = 0%, p = 0.98; HOMA-IR I 2 = 5.9%, p = 0.38) with evidence of low publication bias. Flavanol-rich interventions (2-26 weeks; 88 to 1344 mg flavanols/day) decreased both insulin (SMD −0.25, 95% CI −0.33; −0.16) and HOMA-IR (SMD −0.26; 95% CI −0.36, −0.16). Results were consistent across subgroups (Q tests) with lack of effect in subgroups with BMI<25 or male subjects only; multivariate meta-regression showed that baseline BMI (overweight versus lean, coef. −1.07; 95% CI −2.03, −0.08; p = 0.03) and study location (Asia versus other sites, coef. 0.94; 95% CI 0.03,1.84; p = 0.04) impacted on the effect on HOMA-IR significantly. There was no impact of age, gender, baseline BMI or geographical location on the effect on insulin. Flavanols from tea, apple and cocoa were effective in modulating insulin and HOMA-IR. Inter-individual variability in the response was limited in contrast to previous studies (1,2). This could be partly explained by the small number of trials reporting data for specific subgroups, and the broad range of doses and duration tested among the studies.
interferential current on relieving the pain of musculoskeletal origin: a protocol of a systematic review and meta-analysis.
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