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Document: 8
Ultrasound therapy in musculoskeletal disorders: a meta-analysis.
Gam A N, Johannsen F.
Ultrasound therapy in musculoskeletal disorders: a meta-analysis.
Pain,
1995,
63(1),
pp. 85-91
Record status
This record is a structured abstract written by CRD reviewers. The original
has met a set of quality criteria.
Author's objective
To evaluate the effectiveness of therapeutic ultrasound in the treatment of
pain in musculoskeletal disorders. Type of intervention
Treatment
Specific interventions included in the review
Ultrasound therapy
Participants included in the review
People with musculoskeletal disorders (lateral epicondylitis, bursitis of the
shoulder, osteoarthritis of the knee, traumatized perineum, periarthroisis
humeroscapularis, shoulder pain after hemiplegi, ankel distorsion, breast pain
after delivery, tendinitis of the shoulder and elbow, low back pain,
myofascial pain).
Outcomes assessed in the review
Pain and functional ability (Visual Analogue Scale (VAS) and other pain
scales, global preference, pain at pressure, analgetics usage, grip strength,
wrist bending, functional capacity, McGill Pain Questionnaire, range of
motion, walking distance, muscle strength) and x-ray (reduction of
calcification).
Study designs of evaluations included in the review
Clinical trials comparing ultrasound with alternative treatment or control
group.
What sources were searched to identify primary studies?
Index Medicus (1950-1966) and Medline (1966-1992) using the keywords:
ultrasound therapy and ultrasonic therapy combined with physiotherapy. Papers
in English, German, French, Swedish, Norwegian and Danish were retrieved.
References from retrieved papers were also searched.
Criteria on which the validity (or quality) of studies was assessed
Where available, the following information was abstracted from each trial:
selection, inclusion and exclusion criteria; and description of drop-outs,
randomisation and blinding.
How were the judgements of validity (or quality) made?
Not stated
How were decisions on the relevence of primary studies made?
Not stated
How was the data extracted from primary studies?
Each paper was independently reviewed by both authors, and the relevant
information abstracted. Agreement was reached by discussion.
Number of studies included
22 studies were identified evaluating 1,953 patients across the various
disorders. 16 studies compared ultrasound with sham-ultrasound, 6 compared
ultrasound with non-ultrasound treatment or an untreated control group. Of
the 16 studies, 13 (1,065 patients) and 9 (883 patients) are used for the two
effect sizes calculated in the meta-analysis.
How were the studies combined?
Two standardised effect sizes (d/r and d/s) were calculated for each study.
d/r was obtained by dividing the difference between the ultrasound effect and
the control group effect by the range of the outcome measurement used. d/s
was obtained by dividing the difference by the standard deviation at baseline.
The mean difference of the standardised effect size were then evaluated over
all the studies. The methods were applied to ultrasound treatment versus
sham-ultrasound, and as the results were not significant it was not applied to
ultrasound treatment versus another treatment, or ultrasound treatment versus
untreated group.
How were differences between studies investigated?
Not stated
Results of the review
Only 13 (9) studies of the 16 identified which compared ultrasound with
sham-ultrasound provided data which enabled pooling using the d/r (d/s)
statistic. The mean standardised effect size was 0.64% (95% CI: -6.7, 7.5%)
for d/r and 0.24 (95% CI: -0.02, 0.49) for d/s. As the results comparing
ultrasound with sham-ultrasound were not significant, the comparison of
ultrasound with non-ultrasound treatment or no treatment were not undertaken.
A t-test to assess the influence of blinding (sufficient versus insufficient)
was not significant for d/r (p=0.78), but significant for d/s (p=0.009).
There was insufficient detail reported in the studies to assess the influence
of proper randomisation or to undertake a dose-response analysis.
Was any cost information reported?
No
Author's conclusions
Given the analgetic effects of non-steroidal anti-inflammatory drugs in
musculoskeletal disorders, the results of this meta-analysis indicates an
unimportant effect of ultrasound treatment. There are problems in undertaking
a meta-analysis of so many different musculoskeletal diseases, where
ultrasound may have a different impact. However, although the pathogenesis
varied, the cause of pains is to some extent always inflammation. No attempt
was made to distinguish between acute and chronic disorders.
CRD commentary
This is a thorough review. However, not enough information on the various
pain scales used in the primary studies is given. The literature searching
was restricted to published studies only, and there is no mention of
handsearching. More information on the individual primary studies would have
been useful, rather than summary percentages over all studies. The
statistical techniques used are not clearly explained, and it is not possible
to tell from the review which studies were included in the meta-analysis.
Subject index terms
Subject Indexing from the National Library of medicine:
Musculoskeletal-Diseases/th [Therapy]; Pain/th [Therapy]; Ultrasonic- Therapy;
Clinical-Trials; Musculoskeletal-Diseases/co [Complications];
Musculoskeletal-Diseases/pp [Physiopathology]; Pain/et [Etiology];
Randomized-Controlled-Trials; Female; Human; Male; Support,-Non-U.S.-Gov't
Correspondence address
Dr. Gam A N, Department of Rheumatology, Bispebjerg Hospital, 2400 Copenhagen
NV, Denmark.
Copyright
University of York, 1998
Database no.: DARE-953146
