Efficacy and safety of focused low-intensity pulsed ultrasound versus pulsed shortwave diathermy on knee osteoarthritis: a randomized comparative trial

Abstract

The aim of this study was to compare the efficacy and safety of focused low-intensity pulsed ultrasound (FLIPUS) with pulsed shortwave diathermy (PSWD) in subjects with painful knee osteoarthritis (OA). In a prospective randomized trial, 114 knee OA patients were randomly allocated to receive FLIPUS or PSWD therapy. The primary outcome was the change from baseline in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total scores. Secondary outcomes included the numerical rating scale (NRS) for pain assessment, time up and go (TUG) test, active joint range of motion (ROM) test, and Global Rating of Change (GRC) scale. Data were collected at baseline, 12 days, 12 weeks and 24 weeks. Patients receiving FLIPUS therapy experienced significantly greater improvements in the WOMAC total scores than patients receiving PSWD therapy at 12 days (mean difference, − 10.50; 95% CI − 13.54 to − 7.45; P = 0.000). The results of the NRS, TUG test, ROM test and GRC scale showed that participants treated with FLIPUS reported less pain and better physical function and health status than those treated with PSWD at 12 days (P = 0.011, P = 0.005, P = 0.025, P = 0.011, respectively). Furthermore, patients in the FLIPUS group showed significant improvements in the WOMAC total scores and NRS scores at 12 weeks (mean difference, − 7.57; 95% CI − 10.87 to − 4.26; P = 0.000 and − 1.79; 95% CI − 2.11 to − 1.47, respectively) and 24 weeks (mean difference, − 6.96; 95% CI − 10.22 to − 3.71; P = 0.000 and − 1.37; 95% CI − 1.64 to − 0.96; P = 0.000, respectively) of follow-up. There were no adverse events during or after the interventions in either group. This study concluded that both FLIPUS and pulsed SWD are safe modalities, and FLIPUS was more effective than PSWD in alleviating pain and in improving dysfunction and health status among subjects with knee OA in the short term.Trial registration: Chinese Clinical Trial Registry, ChiCTR2000032735. Registered 08/05/2020, http://www.chictr.org.cn/showproj.aspx?proj=53413.

The Efficacy of Electromagnetic Diathermy for the Treatment of Musculoskeletal Disorders: A Systematic Review with Meta-Analysis

“…A certain degree of heterogeneity is evidenced in the studies regarding the types of proposed interventions. The diathermy with the highest occurrence was SWD, with 43 studies (63%) [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 ], and MWD had the second highest occurrence with 13 articles (19%) [ 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 ]. One article, Hammad 2019 [ ...…”

“…Twenty-seven studies [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 72 , 73 , 86 , 87 , 88 ] performed the treatment in adults with osteoarthritis (OA), 26 studies concerning knee OA, and 1 study concerning a mixed population affected by knee or hip OA. Of the 27 studies, 22 used SWD, 2 MWD, 2 CRET, and 1 ‘low power radiofrequency electromagnetic radiation’ (LPRER).…”

“…The follow-up results of Akyol 2010 and Bezalel 2010 [ 37 , 39 ] are reported in Table 2 . Four studies [ 41 , 42 , 43 , 44 ] compared SWD with US therapy; 3 studies [ 42 , 43 , 44 ] were pooled (MD 0.39, 95% CI −0.13 to 0.91, random-effects model) with non-significant results ( p = 0.14) and a 58% heterogeneity for the post-treatment assessment (GRADE: very low), Figure 7 . Cetin 2008 [ 41 ] showed no statistically significant differences after treatment between the two interventions for the VAS pain scale.…”

“…Cetin 2008 [ 41 ] showed no statistically significant differences after treatment between the two interventions for the VAS pain scale. The follow-up results of Terzi 2017 [ 42 ] and Jia 2022 [ 42 , 43 ] are reported in Table 2 . Three studies [ 30 , 40 , 41 ] compared SWD with other physical agent therapies (see table of contents for the specific treatment of each of the included studies, Supplementary File S3 .…”

Focused low-intensity pulsed ultrasound alleviates osteoarthritis via restoring impaired FUNDC1-mediated mitophagy

“… 13 Furthermore, in a prospective randomized trial, FLIPUS was more effective than pulsed shortwave diathermy in alleviating pain and in improving dysfunction and health status among subjects with knee OA in the short term. 14 In basic science studies, FLIPUS application promoted ECM production in a surgically induced OA rabbit model by downregulating prostaglandin E2 and nitric oxide, joint effusion volume, and chondrocyte apoptosis. 15 Meanwhile, electron microscopy analysis showed that FLIPUS induced typical autophagosomes that enclosed mitochondria in degenerative chondrocyte, which indicated that FLIPUS potentially inhibits the apoptosis via mitophagy activation.…”