LIPUS Setting and Combined Effect With Therapeutic Exercise for Knee Osteoarthritis: A Systematic Review

Abstract

[PURPOSE] Knee osteoarthritis (OA) is a chronic progressive disorder characterized by pain and decreased joint function. In the conservative treatment for the knee OA, the physiotherapy is known to be a common intervention. Recently, low-intensity pulsed ultrasound therapy (LIPUS) which has an effect on knee pain of knee OA has been used with therapeutic exercise. However, the combined effect of LIPUS with therapeutic exercise did not have enough evidence.This study was conducted to assess both setting off the LIPUS and combined effect of the therapeutic exercise in the Knee OA.[METHODS] PubMed, PEDro, CENTRAL were searched for RCTs on published before September 2019. The irradiation intensity, irradiation site, and treatment period of LIPUS were examined. Meta-analysis was performed to analyze the short and long term combined effect which was LIPUS with therapeutic exercise on the VAS score. Statistical calculations of both LIPUS with therapeutic exercise group and only therapeutic exercise group were compared from detailed data of the all eligible studies [RESULTS] Seven RCTs were eligible. Both irradiation intensity and site were varied. Three RCTs were included in the meta-analysis, involving a total of 210 knees. There was no significant improvement in pain in the LIPUS with therapeutic exercise (LIPUS) group compared with the therapeutic exercise group in short-term (MD; -6.86, 95% CI; -18.70 to 4.99 , I2 = 74%, heterogeneity: P = 0.02) and long-term (MD; -16.01 95% CI; -32.03 to 0.01, I2 = 82%, heterogeneity: P = 0.004) effects.[CONCLUSIONS]We did not find consistent evidence of the effects of combined to LIPUS and therapeutic exercise for Knee OA. Because, selected trials were varied in intensity and irradiation site and treatment durations, which might contribute to the existence of heterogeneity. Furthermore, there were few RCTs that resulted in knee joint function.The LIPUS combined therapeutic exercise found no significant decrease the knee pain than therapeutic exercise. Therefore, RCTs were recommended by well-designed intensity and irradiation site.