Effect of pulsed short-wave diathermy on pain and function of subjects with osteoarthritis of the knee: A placebo-controlled double-blind clinical trial

Physical Therapy Department, University of Haifa, Israel.
Clinical Rehabilitation (Impact Factor: 2.24). 06/2005; 19(3):255-63. DOI: 10.1191/0269215505cr864oa
Source: PubMed


To examine the effects of pulsed short-wave diathermy (PSWD), delivered at an intensity sufficient to induce a thermal sensation and at an athermal intensity, in comparison with a placebo short-wave diathermy treatment, on reported pain, stiffness and functional ability and on mobility performance of patients with osteoarthritis of the knee.
A placebo-controlled double-blind trial with sequential allocation of patients to different treatment groups.
Outpatient physiotherapy department.
One hundred and three consecutive patients, mean age 73.7 (+/-6.6) years with osteoarthritis of one or both knees for at least three months.
All participants received three 20-min-long treatments per week for three weeks. One group received PSWD with mean power of 18 W (thermal effect), one group received PSWD with mean power of 1.8 W (athermal effect), and one group received sham short-wave diathermy treatment. Patients were assessed before the initial treatment, immediately following the last treatment, and at a three-month follow-up.
Outcome measures included the WOMAC Osteoarthritis Index, which assessed reported pain, stiffness, and functional ability, and four measures of mobility performance: Timed Get Up and Go test (TGUG), stair-climbing, stair, descending and a 3-min walk.
A difference across time was observed for the pain and stiffness categories of the WOMAC Osteoarthritis Index (p = 0.033 and p = 0.008, respectively), with no differences between groups. No other significant differences across time or between groups were observed in any of the other measures.
The findings do not demonstrate pulsed short-wave diathermy, as it is utilized in clinical settings, to be effective in the treatment of osteoarthritis of the knee.

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    • "OA represents osteoarthritis; BMI, body mass index; PSWD, pulsed shortwave diathermy; SWD, shortwave diathermy; and MWD, microwave diathermy. LEVEL 1 Authors and Date Fukuda et al (2008) Giombini et al (2006) LEVEL 1 Akyol et al (2010) Dziedzic et al (2005) Laufer et al (2005) Marks et al (1999) LEVEL 2 Authors and Date Fukuda et al (2011) Ahmed et al (2009) Jan (2006) LEVEL 2 Buzzard et al (2003) POSITIVE OUTCOMES Characteristics of Subjects (age, gender, diagnosis) N=84 female patients > 40 years of age (group 1 mean ages 57 ± 9 years, group 2 63 ± 9 years) with OA knee Grade II or III and chronic pain > 3 months. BMI ≤ 40. "
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    ABSTRACT: Background and Purpose: Diathermy is a therapeutic modality that has been used for orthopaedic injuries. However, the usefulness and therapeutic benefits of diathermy are not well understood in comparison with other modalities. Therefore, the purpose of this literature review was to provide a summary of evidence that evaluates the clinical utility of diathermy as an intervention for musculoskeletal patholo-gies. Methods: An on-line database search for peer-reviewed, research articles was per-formed that addressed the use of diathermy and its effects on orthopaedic conditions. Articles were then classified by Level of Evi-dence. Findings: Limited positive results (Levels I, II, IV) suggested that diathermy may be beneficial for the treatment of knee osteoarthritis, supraspinatus tendinopathy, and chronic low back pain. However, the overall conflicting results does not allow for a generalized recommendation to be made. Clinical Relevance: Although some evidence has been reported to support the use of diathermy, additional large-scale, ran-domized controlled trials are necessary to fully support or refute the effectiveness of diathermy. BACKGROUND Diathermy has had limited use as a therapeutic modality over the last 3 decades. Clinicians may not be comfortable using diathermy in part because they are not familiar with the research related to its use. A review of the literature and summary of evidence related to the clinical use of dia-thermy as an intervention for those with musculoskeletal pathologies is needed to help guide evidence-based practice. Diathermy is a form of electromagnetic wave generation with frequency ranges that can be categorized as either microwave or shortwave. Shortwave diathermy is also described as either continuous shortwave diathermy (CSWD) or pulsed shortwave diathermy (PSWD). 1 Diathermy involves generation of oscillating electromagnetic fields (EMF) that are comprised of both electrical and magnetic fields. Variations in strength of these fields are dependent upon several factors including the frequency of the unit and characteristics of the applicator. Diathermy is generally described to decrease pain, increase metabolic functions, increase deep tissue temperature, and increase range of motion (ROM). Contraindications to the use of this modality include application over metal, 10,11 metabolic conditions, and pace-makers 12 although practice can differ from manufacturer's guidelines. 6 A review of current literature allows a clinician to apply evidence-based practice when selecting intervention for their patients. Considerations for subjects' characteristics, including age and diagnosis, as well as the methods of application are important when deciding how research can be applied to clinical practice. The purpose of this paper is to review the literature and provide a summary of evidence that supports or refutes the clinical use of diathermy as an intervention for those with musculoskeletal pathologies.
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    ABSTRACT: Osteoarthritis is the most common joint affec- tion in humans. Women are twice as often af- fected as men. Incidence and prevalence are expected to notably rise further within the next years. In therapy, all common methods should be used fi rst. To those methods belong appropriate or modifi ed shoes, walking sticks as well as other orthopaedic-technical methods. The most impor- tant risk factor to be infl uenced is body weight; here, the patient ' s personal responsibility for the progression of his disease has to be adressed as well as physical activity. Physical expedients should accompany the therapy, although there is no very good evidence from clinical studies for many often-used methods. The same applies to acupuncture, which should be used as therapy of osteoarthritis in the knee, although the issue of the functioning mechanism has not been clarifi ed yet. Corticoids could be applicated intraarticular- ly under strictly aseptic conditions in single cases with an acutely infl amed knee. Ultrasound wave therapies, magnet fi eld therapies, diathermy and shock wave therapies are to be rejected. Osteoto- mies could be used in static malfunctioning. Def- inite joint replacement with total endoprothesis is a well-documented intervention in regard to pain reduction and function improvement, but it should only be considered after all other options are tried without success. On the actual research basis, it can ' t be stated if minimal invasive or ro- botic methods are superior.
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