Wireless Versus Wired Iontophoresis for Treating Patellar Tendinopathy: A Randomized Clinical Trial

Rigby, Justin H.; Mortensen, Brett; Draper, David

doi:10.4085/1062-6050-50.11.04

Cited by 10 publications

(16 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Three out of nine trials investigated athletes with PT,26 34 35 two included physically active participants with PT24 35 and four trials enrolled patients with PT without reporting any information on sports participation 23 25 36 37. Pain was assessed in eight;23–26 34 36–38 function was assessed in all nine included trials 23–26 34–38. Pain was assessed with a 0–10 Visual Analogue Scale,25 36–38 the 0–100 millimetre scale (transformed to a 0–10 scale)26 or with pressure sensitivity (kilograms transformed to a 0–10 scale) 23.…”

Section: Resultsmentioning

confidence: 99%

“…Pain was assessed in eight;23–26 34 36–38 function was assessed in all nine included trials 23–26 34–38. Pain was assessed with a 0–10 Visual Analogue Scale,25 36–38 the 0–100 millimetre scale (transformed to a 0–10 scale)26 or with pressure sensitivity (kilograms transformed to a 0–10 scale) 23. For pain, higher scores indicated worse symptoms.…”

Section: Resultsmentioning

confidence: 99%

“…For the purpose of this review, ‘conservative treatment’ was defined as any intervention that did not involve an invasive procedure (injection/surgery) and/or medication. ‘Patellar tendinopathy’ was defined as persistent pain in the patellar tendon for at least 1 month during sports practice or physical activity in people aged 18 years or older (whether or not confirmed through a radiological exam) 23 26…”

Section: Methodsmentioning

confidence: 99%

“…When more than one follow-up was available, we considered those closest to the end of the intervention as the short-term, and closest to 12 months after baseline as the medium/long-term follow-up of interest. When trials compared more than one CT (wired and wireless patch iontophoresis;23 eccentric exercises and heavy slow resistance training26) with a comparator of interest (sham treatment;23 corticosteroids injections),23 26 26 we combined outcome data from the investigated CTs, following Cochrane recommendations 29. The calculations used for these outcomes according to the recommendations, are detailed in online supplementary appendix 2.…”

Section: Methodsmentioning

confidence: 99%

“…Previous systematic reviews on PT have evaluated the effectiveness of individual CT or combinations of CT with an invasive treatment;16 18–22 however, these reviews do not properly inform clinical practice on which CT is recommended for PT management16 18–22 as they all suffer from serious methodological limitations. In addition, since the publication of these reviews,15 16 18 19 22 new high-quality randomised controlled trials (RCTs) have been published which may provide different insights for PT management 23–25…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

How strong is the evidence that conservative treatment reduces pain and improves function in individuals with patellar tendinopathy? A systematic review of randomised controlled trials including GRADE recommendations

et al. 2019

View full text Add to dashboard Cite

ObjectiveTo determine the effectiveness of conservative treatment (CT) on pain and function in patients with patellar tendinopathy (PT) compared with minimal intervention (MI) or other invasive intervention, or in addition to decline eccentric squat.MethodsSearches were performed in MEDLINE, Embase, Cochrane, PEDro, SPORTDiscus, CINAHL and AMED databases. All randomised trials that evaluated CT (any intervention not involving invasive procedures or medication) in individuals with PT were included. Two reviewers screened studies, extracted data and assessed risk of bias of all included studies. Where suitable, meta-analyses were conducted; we assessed certainty of the evidence using GRADE methodology.ResultsWhen compared with MI, CT did not improve pain (weighted mean difference (WMD) −2.6, 95% CI −6.5 to 1.2) or function (WMD 1.8, 95% CI −2.4 to 6.1) in the short-term (up to 3 months) follow-up. When compared with invasive intervention, CT did not improve pain (WMD 0.7, 95% CI −0.1 to 1.4) or function (WMD −6.6, 95% CI −13.3 to 0.2) in the short-term follow-up. No overall effects were found for combined CT (when a conservative intervention was added to decline eccentric squat) on pain (WMD −0.5, 95% CI −1.4 to 0.4) or function (WMD −2.3, 95 % –9.1 to 4.6) at short-term follow-up. Single studies showed an effect on pain with iontophoresis at short-term follow-up (d = 2.42) or dry needling at medium/long-term follow-up (d = 1.17) and function with exercise intervention at medium/long-term follow-up (over 3 months) (d = 0.83).Summary/ConclusionOur estimates of treatment effect have only low to very low certainty evidence to support them. This field of sports medicine/sports physiotherapy urgently needs larger, high-quality studies with pain and function among the potential primary outcomes.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

How strong is the evidence that conservative treatment reduces pain and improves function in individuals with patellar tendinopathy? A systematic review of randomised controlled trials including GRADE recommendations

et al. 2019

View full text Add to dashboard Cite

show abstract

Effects of Ice Massage Prior to an Iontophoresis Treatment Using Dexamethasone Sodium Phosphate

Smith¹,

Draper²,

Hyldahl³

et al. 2021

Journal of Sport Rehabilitation

View full text Add to dashboard Cite

Context: Low current intensity iontophoresis treatments have increased skin perfusion over 700% from baseline potentially altering drug clearance from or diffusion to the targeted area. Objective: To determine the effects of a preceding 10-minute ice massage on subcutaneous dexamethasone sodium phosphate (Dex-P) concentration and skin perfusion during and after a 4-mA iontophoresis treatment. Design: Controlled laboratory study. Setting: Research laboratory. Patients or Other Participants: Twenty-four participants (male = 12, female = 12; age = 25.6 [4.5] y, height = 173.9 [8.51] cm, mass = 76.11 [16.84] kg). Intervention(s): Participants were randomly assigned into 2 groups: (1) pretreatment 10-minute ice massage and (2) no pretreatment ice massage. Treatment consisted of an 80-mA·minute (4 mA, 20 min) Dex-P iontophoresis treatment. Microdialysis probes (3 mm deep in the forearm) were used to assess Dex-P, dexamethasone (Dex), and its metabolite (Dex-Met) concentrations. Skin perfusion was measured using laser Doppler flowmetry. Main Outcome Measure(s): Microdialysis samples were collected at baseline, at conclusion of treatment, and every 20 minutes posttreatment for 60 minutes. Samples were analyzed to determine Dex-Total (Dex-Total = Dex-P + Dex + Dex-Met). Skin perfusion was calculated as a percentage change from baseline. A mixed-design analysis of variance was used to determine Dex-Total and skin perfusion difference between groups overtime. Results: There was no difference between groups (P = .476), but [Dex-Total] significantly increased over the course of the iontophoresis and posttreatment time (P < .001). Dex-P was measured in 18 of 24 participants with a mean concentration of 0.67 (1.09) μg/mL. Skin perfusion was significantly greater in the no ice treatment group (P = .002). Peak skin perfusion reached 27.74% (47.49%) and 117.39% (103.45%) from baseline for the ice and no ice groups, respectively. Conclusions: Ice massage prior to iontophoresis does not alter the tissue [Dex-Total] even with less skin perfusion.

show abstract

Management of patellar tendinopathy: a systematic review and network meta-analysis of randomised studies

Challoumas

Pedret²,

Biddle

et al. 2021

BMJ Open Sport Exerc Med

View full text Add to dashboard Cite

ObjectivesWe performed a systematic review and network meta-analysis (NMA) of randomised controlled trials (RCTs) to provide insights into the effectiveness of available treatment modalities in patellar tendinopathy(PT).MethodsSeveral databases were searched in May 2021 for RCTs assessing the effectiveness of any intervention compared with any other intervention, placebo or no treatment for pain and/or function in PT. The risk of bias and strength of evidence were assessed with the Cochrane Collaboration and GRADE (Grading of Recommendations, Assessment, Development and Evaluations)/GRADE-NMA tools.ResultsA total of 37 RCTs were eligible that assessed 33 different interventions and their combinations, most represented by single studies. Based on pairwise meta-analyses of two RCTs, extracorporeal shockwave therapy (ESWT) does not appear to be superior to sham ESWT (eccentric exercise in both groups) for short-term pain (mean differences (MD) +0.1, 95% CI (−0.8 to 1), p=0.84) or function (MD −1.8, 95% CI (–8 to 4.4), p=0.57). Based on a pairwise meta-analysis of three RCTs, isometric exercise appears as effective as isotonic exercise for immediate postintervention pain relief (MD −1.03, 95% CI (−2.6 to 0.5), p=0.19). Our NMA showed that topical glyceryl trinitrate (GTN) and hyaluronic acid injection, both combined with eccentric exercise and moderate, slow resistance exercise had the highest probability of being the most effective interventions (low/very low strength of evidence).ConclusionsPromising interventions with inadequate evidence, such as topical GTN, hyaluronic acid injections and isometric and slow resistance exercise, should be further investigated through high-quality RCTs. Meanwhile, eccentric loading with or without adjuncts should remain the first-line treatment for all individuals with patellar tendinopathy.

show abstract

Wireless Versus Wired Iontophoresis for Treating Patellar Tendinopathy: A Randomized Clinical Trial

Cited by 10 publications

References 34 publications

How strong is the evidence that conservative treatment reduces pain and improves function in individuals with patellar tendinopathy? A systematic review of randomised controlled trials including GRADE recommendations

How strong is the evidence that conservative treatment reduces pain and improves function in individuals with patellar tendinopathy? A systematic review of randomised controlled trials including GRADE recommendations

Effects of Ice Massage Prior to an Iontophoresis Treatment Using Dexamethasone Sodium Phosphate

Management of patellar tendinopathy: a systematic review and network meta-analysis of randomised studies

Contact Info

Product

Resources

About