Ultrasound therapy in musculoskeletal disorders: a meta-analysis

Abstract

We have reviewed 293 papers published since 1950 to assess the evidence of effect of ultrasound in the treatment of musculoskeletal disorders. Twenty-two clinical papers describing trials comparing ultrasound treatment with sham-ultrasound treated, non-ultrasound treatment and untreated groups were found. These papers were evaluated with respect to a list of criteria which should be met in this type of trial. They were generally found lacking with respect to description of drop-outs, randomisation methods, ultrasound apparatus, sham-ultrasound apparatus, control of apparatus, mode of delivery, size of sound-head, treated area and follow-up time. In 16 of these trials, ultrasound treatments were compared with sham-ultrasound and in 13 cases data were presented in a way that made pooling possible. Two standardized effect sizes (dd/r and dd/s) were applied to the results to enable evaluation of the effect of ultrasound treatment on pain. None of the methods (dd/r = 0.64%, confidence limits -6.7 to 7.5%; and dd/s = 0.24, confidence limits -0.01 to 0.49) gave evidence that pain relief could be achieved by ultrasound treatment. Hence we found no reason to analyze the other papers where ultrasound treatment was compared with another treatment or an untreated control group. We found a significant influence of degree of blinding using the d/s for the analysis (t test, P = 0.009), while when the d/r was used, only a trend was found (P = 0.10). An analysis of the effect of proper randomisation on the result was not possible because of inadequate description of the methods used. We conclude that the use of ultrasound in treatment of musculoskeletal disorders is based on empirical experience, but is lacking firm evidence from well-designed controlled studies. One question remaining is whether ultrasound treatment can augment an effect of exercise therapy with respect to musculoskeletal disorders.

The effectiveness of therapeutic ultrasound for musculoskeletal conditions of the lower limb: A literature review

“…The overall findings of the review are in agreement with other authors who have been unable to find any firm evidence that ultrasound is effective for musculoskeletal disorders. Gam and Johannsen [9] and Van der Windt [10] considered a variety of musculoskeletal disorders of the body (lateral epicondylitis, shoulder pain, rheumatic disorders and others) whereas this review was specific to the lower limb and incorporated the most current research available. It was evident from this review that more attention has been given to the production of higher quality studies in more recent years, which could be attributed to the emphasis placed by the CONSORT statement [24].…”

“…It is thought that despite evidence from laboratory studies in vitro and on animal models there is still minimal evidence to support a clinical beneficial effect; Robertson and Baker [8], Gam and Johannsen [9] and Van der Windt et al [10] were unable to find sufficient evidence from well-designed controlled studies to recommend ultrasound as an effective therapeutic intervention. Watson [11] would argue that ultrasound is effective when applied appropriately and states that to achieve maximum therapeutic benefit there is a definite 'electrotherapeutic window', commonly missed due to incorrect application and dosage selection.…”

Efficacy of conventional ultrasound therapy on myofascial pain syndrome: a placebo controlled study

“…[20] However, the dose of the US applied, treatment duration, the area and type of the treated tissue vary in most of the studies reviewed. In their meta-analysis and systematic review, Robertson [18] and Gam [21] stated that comparison of the study results is complicated due to the technical differences and combination of US therapy with other treatment types in several studies.…”

Untitled

“…[13] Many experimental studies have shown various physiological efficacies of US on living tissues [14][15][16][17] and also vigorous evidence indicating the beneficial effects of these mechanical waves in the treatment of disorders involving soft tissues. [18][19][20] Some applications of high-frequency US include treatment of tendon injuries and relief of the short-term pain. [21][22][23] Furthermore, US waves can enhance the healing rate of some acute bone fractures, venous and pressure ulcers, and surgical incisions.…”