Physical Agent Modalities in Early Osteoarthritis: A Scoping Review

Abstract

Early osteoarthritis (EOA) still represents a challenge for clinicians. Although there is no consensus on its definition and diagnosis, a prompt therapeutic intervention in the early stages can have a significant impact on function and quality of life. Exercise remains a core treatment for EOA; however, several physical modalities are commonly used in this population. The purpose of this paper is to investigate the role of physical agents in the treatment of EOA. A technical expert panel (TEP) of 8 medical specialists with expertise in physical agent modalities and musculoskeletal conditions performed the review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) model. The TEP searched for evidence of the following physical modalities in the management of EOA: “Electric Stimulation Therapy”, “Pulsed Electromagnetic field”, “Low-Level Light Therapy”, “Laser Therapy”, “Magnetic Field Therapy”, “Extracorporeal Shockwave Therapy”, “Hyperthermia, Induced”, “Cryotherapy”, “Vibration therapy”, “Whole Body Vibration”, “Physical Therapy Modalities”. We found preclinical and clinical data on transcutaneous electrical nerve stimulation (TENS), extracorporeal shockwave therapy (ESWT), low-intensity pulsed ultrasound (LIPUS), pulsed electromagnetic fields stimulation (PEMF), and whole-body vibration (WBV) for the treatment of knee EOA. We found two clinical studies about TENS and PEMF and six preclinical studies—three about ESWT, one about WBV, one about PEMF, and one about LIPUS. The preclinical studies demonstrated several biological effects on EOA of physical modalities, suggesting potential disease-modifying effects. However, this role should be better investigated in further clinical studies, considering the limited data on the use of these interventions for EOA patients.

The effects of low-level laser therapy on muscle strength and functional outcomes in individuals with knee osteoarthritis: a double-blinded randomized controlled trial

“…Laser therapy has been broadly used as a physical modality in clinical rehabilitation 10 . Laser treatment provides various physiological effects for pain management and supports functional activities in knee OA patients 15 , 16 .…”

“…A combination of nonpharmacological and pharmacological interventions is recommended as the first-line therapy for knee OA 7 , 8 . Exercise in conjunction with physical modalities such as ultrasound therapy, electrical stimulation, or laser therapy are involved in pain management and improve the level of disability in individuals with knee OA 9 , 10 . Low-level laser therapy (LLLT), which is non-invasive, has been shown to have significant clinical effects on pain relief through analgesic and anti-inflammatory effects.…”

Intra-Articular Injection of Botulinum Toxin for the Treatment of Knee Osteoarthritis: A Systematic Review of Randomized Controlled Trials

“…The current management of KOA follows a stepwise approach [ 7 ]. Nonpharmacological approaches are recommended as first-line treatment, including exercise and weight loss [ 8 , 9 ]. When conservative treatment is not enough, oral analgesics, such as non-steroidal anti-inflammatory drugs (NSAIDs), can be administered, providing temporary pain relief [ 7 ].…”

A scalable 12-week exercise and education programme reduces symptoms and improves function and wellbeing in people with hip and knee osteoarthritis

“…Exercise is advocated by international guidelines for the management of OA including National Institute for Health and Care Excellence (NICE) and the Osteoarthritis Research Society International (OARSI) ( 10 ). In clinical practice, exercise is often prescribed, either in isolation or combined with physical agent modalities such as intra-articular injections and NSAIDs ( 11 ). Evidence demonstrates that exercise interferes with the progression of OA by affecting pathological changes such as articular cartilage degradation, apoptosis, and the inflammatory response.…”