Our group didn't have a lot of trouble finding research articles about therapeutic ultrasound, however the difficulty came when trying to find good articles that provided sound support for its effectiveness or uneffectiveness. We have summarized articles that support, refute, and are undetermined whether ultrasound is an effective form of treatment for both acute and chronic conditions.
From the time that ultrasound’s interaction with living tissue was first investigated, biological effects have been recognized. These include enhanced blood flow, membrane permeability, connective tissue extensibility and nerve conduction. The effectiveness of ultrasound is still unproven, however the study “Is therapeutic ultrasound effective in treating soft tissue lesions” is attempting to prove that it is, in fact, effective. In this study 76 patients with lateral epicondylitis were treated with an ultrasound used for routine therapy. Part of the patients were treated with a placebo ultrasound. The findings of the study showed that ultrasound enhanced recovery in patients with lateral epicondylitis, but only in 63% of the time. By evaluating the data it was shown that the rate of recovery was better in the patients treated with active ultrasound. There was also a decreased incidence of recurrence in the patients treated with active ultrasound.
Ortas, Turan, Bora and Karakaya (1998) looked at the effectiveness of ultrasound on carpal tunnel syndrome. The results showed that there was a significant decrease in pain and symptoms in the two group with ultrasound (1.5 w/cm2, 0.8 w/cm2), however there was also a decrease in the placebo group (no ultrasound). The author makes the argument that the role of placebo affect should be considered and is a “well-recognized phenomena". Nerve conduction was also seen to have decreased in the groups with ultrasound, whereas the group with placebo ultrasound did not.
In the article, “Ultrasound treatment for treating the carpal tunnel syndrome: randomized “sham” controlled trial,” Ebenbichler et. al. divided the subjects of the study randomly into two groups: treatment group receiving ultrasound, and a “sham” (control) group receiving indistinguishable sham ultrasound treatment for treatment of the patients carpal tunnel syndrome. The treatment group received 20 sessions of ultrasound at 1 MHz. 1.0 W/cm2, pulsed mode for 15 minutes a session. After completion of the sessions, and study, the authors stated that their results show there is evidence that ultrasound treatment is beneficial for short and medium relief of carpal tunnel syndrome.
In a study done by Robertson and Baker, these trials were designed to investigate how active ultrasound works in comparison to a placebo ultrasound. In 8 out of 10 trials reviewed, there were no significant differences found between the active and placebo ultrasound. Each of the 8 studies were designed by different researchers in different labs and found almost identical outcomes. There is also limited data to back dosaging. The limits of these studies lie in the fact that they were all RCTs. There are other ways to obtain information on ultrasound. Many clinicians have found that ultrasound does have a positive effect on their patients. However, with no experimental data showing a significant difference between active and placebo ultrasound, there is no justifications for using ultrasound clinically. A valid criticism of this study is that it took information from 10 different RCT studies. Each study had imprecise details that may have changed the outcome of the studies. However, when all of the flawed studies were excluded there were very few RCTs that studied ultrasound.
This study proves that there is more investigation needed to find the true clinical effectiveness of ultrasound. With the information available at the time of this study there was not enough significant evidence to support the clinical use of ultrasound.
The article “How effective is therapeutic ultrasound in the treatment of heel pain?” by Crawford and Smith used two groups to treat heel pain; one treatment group using ultrasound, and one control group that received a placebo ultrasound treatment. The ultrasound machine was calibrated to 3MHz, 0.5 W/cm2, using a pulsed setting for the treatment group. After the treatments the authors concluded that using ultrasound was no more effective than the control group. The authors believed this because the placebo group received feedback as the “treatment” helped the patients, as did the true treatment group.
In the article “Physiotherapy for patients with soft tissue shoulder disorders” evidence was shown that ultrasound was ineffective as a treatment, however, they did go to great lengths to discuss the “unsatisfactory” methods that were used to come to this conclusion. The article was a systemic computerized literature search and the researchers were looking for information about physiotherapy for soft tissue shoulder injuries. Ultrasound appeared to be their primary target, although there was some discussion about cold therapy, steroid injections, electrical stimulation, low laser therapy and exercise. Some things that they thought led to poor data were varied parameters for ultrasound application (intensity, duration, frequency), the compared treatment was poor or inadequate, poor population selection and follow up. The biggest thing I learned from this article wasn’t that ultrasound with ineffective, it was that we need to make sure that our research is sound research.
References:
Binder, A. (1985). is therapeutic ultrasound effective in treating soft tissue lesions. Retrieved from http://www.bmj.com/highwire/filestream/244698/field_highwire_article_pdf/0.pdf
Crawford, F., & Smith, M. (1996). How effective is theraputic ultrasound int he treatment of heel pain? Annals of the Rheumatic Diseases, 265-267.
Ebenbichler, G. R., Resch, K. L., Nicolakis, P., Wiesinger, G. F., Uhl, F., Ghanem, A.-H., et al. (1998). Ultrasound treatment for treating the capral tunnel syndrome: randomized "sham" controlled trial. British Medical Journal, 731-735.
Oztas, O., Turan, B., Bora, I., & Karakaya, M. K. (1998). Ultrasound therapy effect in carpal tunnel syndrome. Archives of physical medicine and rehabilitation, 79(12), 1540-4. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/9862296
Robertson, V. (2001). A review of therapeutic ultrasound: Effectiveness studies. Journal of the American Physical Therapy Association, 81(7), 1339-1350. Retrieved from http://physther.net/content/81/7/1339.short
van der Heijden, G. J. M. G., van der Windt, D. A. W. M., & de Winter, A. F. (1997). Physiotherapy for patients with soft tissue shoulder disorders: a systematic review of randomised clinical trials. BMJ, 315(7099), 25-30. doi:10.1136/bmj.315.7099.25
Katie B., Amanda L., Michael D.
Therapeutic Ultrasound for Knee Osteoarthritis
ReplyDelete(Kat McNally, Payden Dowling, Katie Salmans)
Osteoarthritis is the most common form of arthritis for which there is no cure. It is a degenerative joint disease that involves the break down of the articular cartilage and causes bony growths into the joint space. It is most commonly found in the hip, knee, hands, and spine. Symptoms associated with the disease are pain, swelling, and stiffness in the affected joint.(1) Therapeutic ultrasound is one of several modalities that can be used to treat the symptoms and loss of function associated with the disease.
Supporting Use of Ultrasound in Knee OA: (2)
In 2013, Luksurapan and Boonhong conducted a randomized, double-blind controlled trail investigating the effects of phonophoresis of piroxicam (PhP) on patients with knee osteoarthritis. Participants had a visual analog (VAS) score from 50 to 92 for knee pain intensity and Kellgren-Lawrence grades of I to III and were randomly allocated into two groups with 23 in each group. One group received PhP phonophoresis and the other a nondrug coupling gel, 5 times a week for 2 weeks using the stroking technique, continuous mode, 1.0 W/cm2 for 10 minutes a session. Upon reassessment both VAS and WOMAC scores were significantly improved after treatment in both groups. This study indicates that the PhP group showed more of a significant improvement than just UT alone and indicates that PhP is a new, effective method of treatment for symptomatic knee OA.
Refuting Use of Ultrasound for Knee OA: (3)
In 2012, Ulus et al. evaluated the effects of therapeutic ultrasound on pain, physical function, ambulation activity, disability, and psychological status in study participants who were positive for osteoarthritis (OA) of the knee. According to the authors, management of knee OA should primarily be directed at reducing pain and maintaining or improving function.
In the study, pain was measured at rest and during activity using a 10-cm visual analog scale; functional ability was measured using the Turkish version of the WOMAC (Western Ontario and McMaster University Osteoarthritis Index); ambulation activity was measured by recording the time required to walk 50 meters as fast as possible; disability measurement was taken via the Lequesne index; and psychological status was evaluated using the Hospital Anxiety and Depression Scale. Baseline assessments were taken for 42 inpatient participants with bilateral knee OA. Participants were part of either Group 1, receiving therapeutic continuous ultrasound, or Group 2, receiving sham ultrasound. Researchers used a 1-MHz frequency and an intensity of 1 W/cm2 for Group 1. Patients in both groups also received additional treatment including hot packs and isometric exercises. While both groups showed significant improvement in each of the evaluated areas, after treatment, researchers found that there was no significant difference between improvements in the therapeutic ultrasound group and the group that received sham ultrasound.
References:
1) http://www.cdc.gov/arthritis/basics/osteoarthritis.htm
2) Luksurapan, W., & Boonhong, J. (2013). Effects of phonophoresis of piroxicam and ultrasound on symptomatic knee osteoarthritis. Archives of physical medicine and rehabilitation, 94(2), 250–5. doi:10.1016/j.apmr.2012.09.025
3) Ulus Y., Tander., B., Akyol, Y., Durmus D., Ozlem B,. Gul U., Canturk F., Bilgici A., Kuru O. Therapeutic ultrasound versus sham ultrasound for the management of patients with knee osteoarthritis: a randomized double-blind controlled clinical study. International Journal of Rheumatic Diseases 2012 Apr;15(2): 197-206. [PMID 22462424]
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