John,
Thanks for the references. I am not familiar with that specific article:
however, I would wager a bet that if you look at the articles they
reviewed, the treatment techniques would be flawed, if they even describe
them.I guess I better go "dig them up" before I say more. Have a good day!!
Rege
At 12:49 PM 1/29/2003 -0800, you wrote:
>Here are a few abstacts regarding the use of ultrasound that seem relevent
>to the discussion. The first is a meta-analysis of the use of us for all
>musculoskeletal condtions of which they essentially found that it was not
>effective, save the possibility of lat epicondylitis (however notice that
>the confidence interval crosses the no effect threshold). the 2nd abstract
>seems to suggest that there is a use for ultrasound in fracture healing.
>There may be some sub-populations that respond to this modality but it may
>also be that the other interventions or placebo/social reciprocity etc
>effects, are being attributed to the ultrasound. One can not forget the
>favourable natural history of these conditions.
>Sincerely,
>John Dufton
>
>ABSTRACT 1
>
>Authors
>van der Windt DA. van der Heijden GJ. van den Berg SG. ter Riet G. de Winter
>AF. Bouter LM.
>
>Title
>Ultrasound therapy for musculoskeletal disorders: a systematic review.
>
>Source
>Pain. 81(3):257-71, 1999 Jun.
>
>Abstract
>BACKGROUND: Ultrasound therapy is used frequently to reduce pain and related
>disability, mainly by physiotherapists. The objective of this review was to
>evaluate the effectiveness of ultrasound therapy in the treatment of
>musculoskeletal disorders. METHODS: Published reports of randomized clinical
>trials investigating the effects of ultrasound therapy on pain, disability
>or range of motion were identified by a systematic search of MEDLINE, EMBASE
>and the Cochrane databases, supplemented with citation tracking. The quality
>of methods of all selected publications was assessed systematically by two
>independent and 'blinded' reviewers, using ten validity criteria. Data from
>the original publications were used to calculate the differences between
>groups for success rate, pain, disability and range of motion. Statistical
>pooling was performed if studies were homogeneous with respect to study
>populations, interventions, outcome measures and timing of follow-up.
>RESULTS: 38 Studies were included in the review, evaluating the effects of
>ultrasound therapy for lateral epicondylitis (n = 6), shoulder pain (n = 7),
>degenerative rheumatic disorders (n = 10), ankle distorsions (n = 4),
>temporomandibular pain or myofacial pain (n = 4) and a variety of other
>disorders (n = 7). In 11 out of 13 placebo-controlled trials with validity
>scores of at least five out of ten points, no evidence of clinically
>important or statistically significant results was found. Statistical
>pooling was only feasible for placebo-controlled trials on lateral
>epicondylitis, and produced a pooled estimate for the difference in success
>rate of 15% (95% confidence interval -8%-38%). CONCLUSIONS: As yet, there
>seems to be little evidence to support the use of ultrasound therapy in the
>treatment of musculoskeletal disorders. The large majority of 13 randomized
>placebo-controlled trials with adequate methods did not support the
>existence of clinically important or statistically significant differences
>in favour of ultrasound therapy. Nevertheless, our findings for lateral
>epicondylitis may warrant further investigation.
>
>ABSTRACT 2
>Authors
>Busse JW. Bhandari M. Kulkarni AV. Tunks E.
>
>Title
>The effect of low-intensity pulsed ultrasound therapy on time to fracture
>healing: a meta-analysis. [Review] [49 refs]
>
>Source
>CMAJ. 166(4):437-41, 2002 Feb 19.
>
>Abstract
>BACKGROUND: The effect of low-intensity ultrasonography on fracture healing
>is controversial, and current management of fractures does not generally
>involve the use of ultrasound therapy. We describe a systematic review and
>meta-analysis of randomized controlled trials of low-intensity pulsed
>ultrasound therapy for healing of fractures. METHODS: We searched 5
>electronic databases (MEDLINE, EMBASE, Cochrane Database of Randomised
>Clinical Trials, HealthSTAR and CINAHL) for trials of ultrasonography and
>fracture healing, in any language, published from 1966 to December 2000. In
>addition, selected journals published from 1996 to December 2000 were
>searched by hand for relevant articles, and attempts were made to contact
>content experts in the area of ultrasound therapy and fracture healing as
>well as primary authors of reviewed trials. Trials selected for review met
>the following criteria: random allocation of treatments; inclusion of
>skeletally mature patients of either sex with 1 or more fractures; blinding
>of both the patient and the assessor(s) as to fracture healing;
>administration of low-intensity pulsed ultrasound treatments to at least 1
>of the treatment groups; and assessment of time to fracture healing, as
>determined radiographically by bridging of 3 or 4 cortices. Two reviewers
>independently applied selection criteria to blinded articles, and selected
>articles were scored for methodologic quality. The internal validity of each
>trial was assessed with the use of a 5-point scale that evaluates the
>quality of trial method on the basis of description and appropriateness of
>randomization and double-blinding, and assessment of study withdrawals and
>likelihood of bias. RESULTS: We identified 138 potentially eligible studies,
>of which 6 met our inclusion criteria. Agreement beyond chance of quality
>assessments of the 6 trials was good (intraclass correlation coefficient
>0.77, p = 0.03). One trial was a repeat analysis of previously reported
>data, and 2 trials appeared to report on a shared group of subjects. Three
>trials, representing 158 fractures, were of sufficient homogeneity for
>pooling. The pooled results showed that time to fracture healing was
>significantly shorter in the groups receiving low-intensity ultrasound
>therapy than in the control groups. The weighted average effect size was
>6.41 (95% confidence interval 1.01-11.81), which converts to a mean
>difference in healing time of 64 days between the treatment and control
>groups. INTERPRETATION: There is evidence from randomized trials that
>low-intensity pulsed ultrasound treatment may significantly reduce the time
>to fracture healing for fractures treated nonoperatively. There does not
>appear to be any additional benefit to ultrasound treatment following
>intramedullary nailing with prior reaming. Larger trials are needed to
>resolve this issue. [References: 49]
>
>
>
>
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