Shortwave Diathermy Research Articles

A SUCCESSFUL TREATMENT OF BLOCKED FALLOPIAN TUBES FOLLOWING SHORT WAVE DIATHERMY

To evaluate for the first time the role of short wave diathermy (SWD) in the treatment of blocked fallopian tubes of tubal infertility. METHODOLOGY: This is a case control study that investigated women with primary and secondary tubal infertility. The study was comprised of 50 patients as cases and 15 patients as controls. Cases were exposed to SWD while the controls were not subjected to the SWD. The main outcome measure was fallopian tubes patency. RESULTS: After one month of treatment, fertile fallopian tubes were nonspecifically indicated by HSG in 84% (42/50) of the cases but none of the controls (0/15) showed any significant improvement in their condition. This difference was found to be statistically significant (P CONCLUSION: The use of SWD is highly successful in the treatment of fallopian tube patency.

Postfixed Brachial Plexus Radiculopathy Due to Thoracic Disc Herniation in a Collegiate Wrestler: A Case Report

To present the unique case of a collegiate wrestler with C7 neurologic symptoms due to T1-T2 disc herniation. A 23-year-old male collegiate wrestler injured his neck in a wrestling tournament match and experienced pain, weakness, and numbness in his left upper extremity. He completed that match and 1 additional match that day with mild symptoms. Evaluation by a certified athletic trainer 6 days postinjury showed radiculopathy in the C7 distribution of his left upper extremity. He was evaluated further by the team physician, a primary care physician, and a neurosurgeon. Cervical spine injury, stinger/burner, peripheral nerve injury, spinal cord injury, thoracic outlet syndrome, brachial plexus radiculopathy. The patient initially underwent nonoperative management with ice, heat, massage, electrical stimulation, shortwave diathermy, and nonsteroidal anti-inflammatory drugs without symptom resolution. Cervical spine radiographs were negative for bony pathologic conditions. Magnetic resonance imaging showed evidence of T1-T2 disc herniation. The patient underwent surgery to resolve the symptoms and enable him to participate for the remainder of the wrestling season. Whereas brachial plexus radiculopathy commonly is seen in collision sports, a postfixed brachial plexus in which the T2 nerve root has substantial contribution to the innervation of the upper extremity is a rare anatomic variation with which many health care providers are unfamiliar. The injury sustained by the wrestler appeared to be C7 radiculopathy due to a brachial plexus traction injury. However, it ultimately was diagnosed as radiculopathy due to a T1-T2 thoracic intervertebral disc herniation causing impingement of a postfixed brachial plexus and required surgical intervention. Athletic trainers and physicians need to be aware of the anatomic variations of the brachial plexus when evaluating and caring for patients with suspected brachial plexus radiculopathies.

Efeitos da diatermia por ondas curtas no torque do músculo quadríceps femoral durante a estimulação elétrica neuromuscular e contração voluntária em indivíduos saudáveis

INTRODUÇÃO: A influência dos efeitos do calor no torque em indivíduos de ambos os gêneros é desconhecida, principalmente quando associado à estimulação elétrica. OBJETIVOS: Analisar o efeito da diatermia por ondas curtas no torque do músculo quadríceps femoral gerado pela contração voluntária e eletricamente induzida em indivíduos assintomáticos de ambos os gêneros e avaliar o desconforto gerado pela corrente elétrica. MÉTODOS: Participaram do estudo 26 voluntários, onde foi avaliada a capacidade de produção de torque em um dinamômetro isocinético através de contrações isométricas voluntárias máximas (CIVM) e eletricamente induzida (TEI). Os voluntários foram submetidos a quatro momentos: mensuração do torque através de contração voluntária, contração voluntária após aplicação do calor, contração eletricamente induzida e contração eletricamente induzida após aplicação do calor. O desconforto sensorial durante a estimulação elétrica foi avaliado com a escala visual analógica (EVA). RESULTADOS: O torque no sexo masculino foi maior quando submetido à aplicação da corrente elétrica associado ao calor (p = 0,030). Em relação ao desconforto gerado pela corrente elétrica, foi observado aumento no sexo feminino quando associado ao calor (p = 0,044) comparado ao sexo masculino. CONCLUSÃO: A diatermia por ondas curtas não influenciou o torque produzido pela contração voluntária, porém houve aumento do torque eletricamente induzido (TEI) após aplicação de calor em indivíduos do sexo masculino e aumento do desconforto sensorial gerado pela corrente apenas nos sujeitos do sexo feminino.

English

INTRODUCTION: Low back pain is a common reason for seeing a physiotherapist in primary care. The goal for the therapist managing these patients is to select the appropriate treatment for each patient. The medical professionals in primary care most commonly classify these patients with patho-anatomically labeled categories. However, there appear to be a wide diversity in the opinion as to the pattern of signs and symptoms. There is strong evidence that exercise therapy is more effective than usual care by general practitioners, and that exercise therapy and conventional physiotherapy (consisting of a combination of hot packs, massage, traction, mobilization, short wave diathermy, ultrasound etc.) are equally effective for the treatment of these patients. McKenzie extension exercises help in reducing the pain and increase the mobility as compared to the conventional physiotherapy treatment alone. AIM & OBJECTIVE: Present study done to compare efficacy of McKenzie extension exercise over conventional method of short wave diathermy in extension dysfunction syndrome. MATERIAL & METHOD: Total 30 samples (patients) of age 35-50 years were selected. Patients with complaint of low back pain were further assessed to diagnose extension dysfunction syndrome. Study was Quasi experimental in nature, randomized technique was adopted. Patients kept under control group received short wave diathermy only whereas patients kept in experimental group received McKenzie extension exercise in addition to short wave diathermy. With the help of VAS (Visual analogue scale) for pain, relief in extension pain assessed in both groups on 1st, 5th, 10th & 15th day of treatment. Test used- independent't' test using SPSS & Graph Pad instat3 (trial version).RESULT: The mean improvement between the initial & final scores of the control group was 4.06 ±1.24 and that of experimental group was 3.45 ±1.08 and on calculation the't' value was found to be 3.24 hence p<0.05 which implies that there was significant difference between two groups.CONCLUSION: There was definite decrease in value of VAS in both the groups but there was more significant improvement in experimental group in comparison to the control group. It may be quite safely stated that McKenzie technique is an effective, scientific and

Comparison of the efficacy of ketoprofen phonophoresis, ultrasound, and short-wave diathermy in knee osteoarthritis

The present study aimed to compare the efficacy of three different deep heating modalities: phonophoresis (PH), short-wave diathermy (SWD), and ultrasound (US), in knee osteoarthritis. Patients who consented to participate in the study were randomly divided into the following three groups. Group 1 (n = 33) received PH, Group 2 (n = 33) received US, and Group 3 (n = 35) received SWD. These deep heating therapies were applied by the same therapist. Each therapy began with 20-min hot pack application. Each of the three physical therapy modalities was applied 5 days a week for 2 weeks (a total of 10 sessions). The patients were evaluated using visual analogue scale (VAS) at rest, 15-m walking time, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) both before and after the treatment. Moreover, at the end of the treatment, both the physician and the patient made an overall evaluation, by rating the treatment efficacy. The results of the study showed that VAS, 15-m walking time, and WOMAC parameters were improved with all three deep heating modalities, and all the three modalities were effective. However, there was no significant difference between the three modalities in terms of efficacy. There was also no significant difference between the three groups in terms of post-treatment general evaluation of the physician and the patient. The present study is the first to suggest that choosing one of PH/US/SWD therapy options would provide effective results and none of them are superior to the others, and we believe that these findings will be a basis for further studies.

Hypothesis generation for targeted back pain treatment

AbstractAimTo create a framework for coordinated testing of treatments on the basis of recognizing common back pain diagnostic subgroups. It is hoped that this approach will help get round the lack of progress encountered with therapeutic trials analyzed on the clumped non-specific back pain approach which has tended to show such small treatment effects.MethodExamination of standardized deviates of patients’ opinions of previous treatment responses according to their subdiagnosis, which was attributed by subsequent classification analysis. The study was performed on a subsection of 490 patients from those screened for entry into a randomized controlled trial of physiotherapy treatments. The questions about past treatment included the following broad categories: hard bed, hot bath, shortwave diathermy, exercises, traction, manipulation, and injections. The response categories were better, no effect, or worse. The common presentation of cases was divided into prolapsed intervertebral disk, switching back pa...

Assessment of Physiotherapists’ Occupational Exposure to Radiofrequency Electromagnetic Fields from Shortwave and Microwave Diathermy Devices: A Literature Review

We reviewed studies reporting the strength of radiofrequency (RF) electromagnetic fields (EMF) in physiotherapists’ occupational environment. Studies from academic journals published from January 1990 to June 2010 were identified in nine online bibliographic databases. EMF strength was compared with occupational exposure limits (OELs) recommended by the International Commission on Non-Ionizing Radiation Protection (ICNIRP). In the reviewed studies, EMFs were measured at different distances (range 0.2 m to 6 m) from the console of diathermy devices, electrodes, and cables. For continuous shortwave diathermy (CSWD) (27.12 megahertz, MHz), measurements of EMFs at < 1 m, 1 m, 1.1–1.5 m, and 2 m reported the maximum E field strength as 8197%, 1639%, 295%, and 69%, respectively, and the maximum H field strength as 6250%, 681%, 213%, and 56%, respectively, of the ICNIRP limits for E and H fields for occupational exposure. For pulsed shortwave diathermy (PSWD) (27.12 MHz), EMF measurements at < 1 m, 1 m, and, 1.1–1.5 m showed the maximum E field intensity as 1639%, 175%, and 32%, and the maximum H field strength as 1175%, 968%, and 28%, respectively, of the ICNIRP limits for E and H fields for occupational exposure. For microwave diathermy (MWD) (2.45 gigahertz, GHz), the maximum power density measured at < 1 m, 1 m, 1.1–1.5 m, and 2 m was 200%, <30%, 0.76%, and 0.82%, respectively, of the ICNIRP limit for occupational exposure. RF EMF emissions measured from continuous and pulsed electrotherapeutic diathermy devices may well be higher than OELs at specific distances, i.e., at 1 m, which is currently designated to be a safe distance for physiotherapists. The minimum safe distance for physiotherapists should be revised to at least 2 m for CSWD and 1.5 m for PSWD. The reviewed studies did not provide evidence of exceeding the ICNIRP's reference levels for occupational exposure at 1 m from MWD devices.

FRI0597-HPR The effect of physical therapy on functional status and synovial perfusion in patients with knee osteoarthritis

BackgroundOsteoarthritis (OA) of the knee is the most common joint disease in the elderly and it is associated with significant physical disability (1). Physiotherapy is widely used to treat the...

Muscle Heating With Megapulse II Shortwave Diathermy and ReBound Diathermy

A new continuous diathermy called ReBound recently has been introduced. Its effectiveness as a heating modality is unknown. To compare the effects of the ReBound diathermy with an established deep-heating diathermy, the Megapulse II pulsed shortwave diathermy, on tissue temperature in the human triceps surae muscle. Crossover study. University research laboratory. Participants included 12 healthy, college-aged volunteers (4 men, 8 women; age = 22.2 ± 2.25 years, calf subcutaneous fat thickness = 7.2 ± 1.9 mm). Each modality treatment was applied to the triceps surae muscle group of each participant for 30 minutes. After 30 minutes, we removed the modality and recorded temperature decay for 20 minutes. We horizontally inserted an implantable thermocouple into the medial triceps surae muscle to measure intramuscular tissue temperature at 3 cm deep. We measured temperature every 5 minutes during the 30-minute treatment and each minute during the 20-minute temperature decay. Tissue temperature at a depth of 3 cm increased more with Megapulse II than with ReBound diathermy over the course of the treatment (F₆,₆₆ = 10.78, P < .001). ReBound diathermy did not produce as much intramuscular heating, leading to a slower heat dissipation rate than the Megapulse II (F₂₀,₂₂₀ = 28.84, P < .001). During a 30-minute treatment, the Megapulse II was more effective than ReBound diathermy at increasing deep, intramuscular tissue temperature of the triceps surae muscle group.

Osteoarthritis year in review: rehabilitation

Purpose: This review will highlight seminal publications of rehabilitation interventions for osteoarthritis (OA) since April 2012. Methods: A systematic literature search was performed in Medline, CINAHL and Embase databases from April 2012 to present using the key words osteoarthritis, rehabilitation, physical therapy, occupational therapy, exercise, and pre-operative intervention limited to human and English. Rehabilitation intervention studies included randomized trials or systematic reviews/meta-analyses or pre-post studies. Pilot randomized trial feasibility studies and studies of surgical interventions unless they included evaluation of a rehabilitation intervention were excluded. Results: As of December 2012, 19 studies were identified for inclusion grouped thematically into: total joint replacement (TJR) pre-habilitation; exercise including walking programs; physical modalities (i.e., radiation, laser, diathermy, transcutaneous electric nerve stimulation, neuromuscular electrical stimulation); other non-pharmacologic interventions (i.e., insoles; combined manual therapy and exercise); and, standard versus accelerated rehabilitation following cartilage repair. A 40-minute education and 4-week home exercise program pre-TJR decreased acute hospital length of stay and hospital-related costs and pre-habilitation plus tid 1 g acetaminophen reduced pain in those pre total knee replacement (TKR) compared to rehabilitation only. The benefits of exercise were demonstrated for a number of outcomes including pain, stiffness, function, balance, biomarkers, and executive function and dual task performance (related to falling) in people with knee OA. Modalities such as 890-nm radiation, interferential current, short wave diathermy and neuromuscular functional electrical stimulation did not demonstrate benefit in those with knee OA. Shock absorbing insoles compared to normal footwear improved knee pain and function but did not decrease knee load. Manual therapy and exercise demonstrated improvements in pain in those with hip OA at 8 and 29 weeks follow-up. Accelerated weight-bearing and rehabilitation (8 versus 11 weeks) was demonstrated to be safe and effective at five years following matrix autologous chondrocyte implantation for cartilage defects in the knee. Conclusions: The literature search will be updated inclusive through March 2013 and results presented.

Heating Capacity of ReBound Shortwave Diathermy and Moist Hot Packs at Superficial Depths

The effectiveness of a new continuous diathermy unit, ReBound, as a heating modality is unknown. To compare the effects of ReBound diathermy with silicate-gel moist hot packs on tissue temperature in the human triceps surae muscle. Crossover study. University research laboratory. A total of 12 healthy, college-aged volunteers (4 men, 8 women; age = 22.2 ± 2.25 years, calf subcutaneous fat thickness = 7.2 ± 1.9 mm). On 2 different days, 1 of 2 modalities (ReBound diathermy, silicate-gel moist hot pack) was applied to the triceps surae muscle of each participant for 30 minutes. After 30 minutes, the modality was removed, and temperature decay was recorded for 20 minutes. Medial triceps surae intramuscular tissue temperature at a depth of 1 cm was measured using an implantable thermocouple inserted horizontally into the muscle. Measurements were taken every 5 minutes during the 30-minute treatment and every minute during the 20-minute temperature decay, for a total of 50 minutes. Treatment was analyzed through a 2 × 7 mixed-model analysis of variance with repeated measures. Temperature decay was analyzed through a 2 × 21 mixed-model analysis of variance with repeated measures. During the 30-minute application, tissue temperatures at a depth of 1 cm increased more with the ReBound diathermy than with the moist hot pack (F6,66 = 7.14, P < .001). ReBound diathermy and moist hot packs increased tissue temperatures 3.69°C ± 1.50°C and 2.82°C ± 0.90°C, respectively, from baseline. Throughout the temperature decay, ReBound diathermy produced a greater rate of heat dissipation than the moist hot pack (F20,222 = 4.42, P < .001). During a 30-minute treatment at a superficial depth, the ReBound diathermy increased tissue temperature to moderate levels, which were greater than the levels reached with moist hot packs.

Effect of therapeutic ultrasound and diathermy on oxidant–antioxidant balance in dogs suffering from hind quarter weakness

The present study was conducted to evaluate the erythrocytic oxidant–antioxidant balance in dogs suffering from hind quarter weakness (HQW) and treated with conventional drug therapy (CDT, n=8) alone and in combination with therapeutic ultrasound (US, n=8) and shortwave diathermy (SWD, n=8). A further eight healthy dogs were used as controls. For oxidant level, Lipid Peroxidation (LPO) and antioxidant levels Reduced Glutathione (GSH), Superoxide Dismutase (SOD) and Catalase (CAT) were evaluated in erythrocyte before (day 0) and after 3, 7, 14 and 28 days of therapy. In dogs with HQW, LPO in terms of Malondialdehyde (MDA) production, was found significantly (P<0.05) increased compared to a healthy control on day 0. Thereafter, a significant (P<0.05) decrease in the level of LPO was noticed. Amongst antioxidant enzymes, activities of GSH and CAT decreased significantly (P<0.05) whereas, the level of SOD increased significantly (P<0.05) until day 28 post treatment. Studies revealed that SWD and therapeutic ultrasound in conjunction with CDT can be used to counter free radical-mediated oxidative cell injury, induced by HQW in dogs. However, SWD proved to be better in minimizing excess free radicals production and activating antioxidant defense system as compared to therapeutic ultrasound.

Comparasion Of The Therapeutic Effect Between SWD And Tens On Relieving Pain In Mechanical Low Back Pain Petients

Background : Low back pain (LBP) is the second cause of pain after headache and remains one of the most common symptoms for seeing a physician. About 90% of LBP is caused by mechanical factor. There are various physical modalities to relieve pain, such as, Short Wave Diathermy (SWD) and Transcutaneus Electrical Nerve Stimulation (TENS) which are proved to be useful to relieve pain. The aim of the study is to compare SWD and TENS on relieving pain in mechanical LBP patients.&#x0D; Methods : A pre-posttest study in 36 outpatients, with subacute mechanical LBP, ranging from 30–55 years old, were randomly divided into two even groups, the SWD group and TENS group. The subjects received either SWD or TENS on lumbosacral area for 15 minutes, 3 times a week, with the interval of 2–3 days during 2 weeks. Visual Analogue Scale (VAS) was applied for pain assessments to all subjects before and 24 hours after the sixth therapy session.&#x0D; Results : There was a reduction on VAS score in the SWD group from 4.56 ± 0.62 cm to 1.90 ± 0.51 cm (p&lt;0.001). There was a reduction on VAS score in the TENS group from 4.64 ± 0.59 cm to&#x0D; 2.03 ± 0.50 cm (p&lt;0.001). There was no significant difference on VAS score reduction between SWD and TENS group (p = 0.643). Conclusion : TENS therapy relieves pain in subacute mechanical LBP patients as good as SWD Therapy.&#x0D; Keywords : Mechanical low back pain, SWD, TENS.

Pelvic floor muscle exercise for chronic low back pain

To assess the effect of pelvic floor muscle exercise in patients with chronic low back pain. Adults (aged ≥ 18 years) with chronic low back pain (with or without radiculopathy) were randomized to undergo either routine treatment (ultrasonography, short wave diathermy and lumbar strengthening exercises; control group) or routine treatment with pelvic floor exercises (intervention group) for 24 weeks. Pain, disability (Oswestry Disability Index [ODI] score) and trunk muscle function were assessed at baseline and after completion of treatment. The study included 47 patients (control group n = 24; intervention group n = 23). Pain severity and ODI scores were significantly lower in the intervention group than in the control group after 24 weeks. There were no significant between-group differences in trunk muscle function. Pelvic floor exercise in combination with routine treatment provides significant benefits in terms of pain relief and disability over routine treatment alone.

Chronic low back pain and treatment with microwave diathermy

Clinical trial of 100 patients of chronic low back ache was conducted in the Department of Physical Medicine and Rehabilitation (PMR) at Sher-i-Kashmir Institute of Medical Sciences Soura a Tertiary care hospital for period of two year from January 2010 to January 2012 to find out effect of Microwave diathermy (MWD). All patients were treated with Microwave diathermy along with conventional treatment. The results were compared and student's 't' test was applied to see the level of significance. A significant improvement after treatment (P=0.000) was found. The present study suggests that short wave diathermy is effective for the treatment of patients with chronic low back pain.

Effect of Maitland Spinal Mobilization Therapy Versus Conventional Therapy in Lumbar Spondylosis with Radiculopathy

Objectives: To compare SMT with conventional therapy in lumbar spondylosis with radiculopathy. Design : Randomized controlled trial. Material : Inch tape, pen , goniometer, SWD , lumbar traction unit , Hot packs. Method: A RCT was done and patients with lumbar spondylosis were allocated in two group. Gr. I received Maitland's mobilization in P-A , rotational and transverse mobilization with hot packs and core stabilization. Gr. 2 received lumbar traction, Shortwave diathermy and core stabilization. Each group had 20 patients and they were evaluated on day one pre treatment and day 30 post treatment. Outcome measures used for assessment were pain on VAS scale, spinal ROM by Schober's test SLR and Oswestry Disability Scale for functional evaluation. Results: Spinal mobilization and conventional therapy both showed improvement in pain and spinal ROM but spinal mobilization however mobilization therapy showed significant improvement than conventional group (t value = 2.149, p < 0.05). SLR & ODI showed improvement within group but not between the two groups. Conclusion : Spinal mobilization is better than routine conventional therapy .

Rehabilitation for ankle fractures in adults.

Rehabilitation after ankle fracture can begin soon after the fracture has been treated, either surgically or non-surgically, by the use of different types of immobilisation that allow early commencement of weight-bearing or exercise. Alternatively, rehabilitation, including the use of physical or manual therapies, may start following the period of immobilisation. This is an update of a Cochrane review first published in 2008. To assess the effects of rehabilitation interventions following conservative or surgical treatment of ankle fractures in adults. We searched the Specialised Registers of the Cochrane Bone, Joint and Muscle Trauma Group and the Cochrane Rehabilitation and Related Therapies Field, CENTRAL via The Cochrane Library (2011 Issue 7), MEDLINE via PubMed, EMBASE, CINAHL, PEDro, AMED, SPORTDiscus and clinical trials registers up to July 2011. In addition, we searched reference lists of included studies and relevant systematic reviews. Randomised and quasi-randomised controlled trials with adults undergoing any interventions for rehabilitation after ankle fracture were considered. The primary outcome was activity limitation. Secondary outcomes included quality of life, patient satisfaction, impairments and adverse events. Two review authors independently screened search results, assessed risk of bias and extracted data. Risk ratios and 95% confidence intervals (95% CIs) were calculated for dichotomous variables, and mean differences or standardised mean differences and 95% CIs were calculated for continuous variables. End of treatment and end of follow-up data were presented separately. For end of follow-up data, short term follow-up was defined as up to three months after randomisation, and long-term follow-up as greater than six months after randomisation. Meta-analysis was performed where appropriate. Thirty-eight studies with a total of 1896 participants were included. Only one study was judged at low risk of bias. Eight studies were judged at high risk of selection bias because of lack of allocation concealment and over half the of the studies were at high risk of selective reporting bias.Three small studies investigated rehabilitation interventions during the immobilisation period after conservative orthopaedic management. There was limited evidence from two studies (106 participants in total) of short-term benefit of using an air-stirrup versus an orthosis or a walking cast. One study (12 participants) found 12 weeks of hypnosis did not reduce activity or improve other outcomes.Thirty studies investigated rehabilitation interventions during the immobilisation period after surgical fixation. In 10 studies, the use of a removable type of immobilisation combined with exercise was compared with cast immobilisation alone. Using a removable type of immobilisation to enable controlled exercise significantly reduced activity limitation in five of the eight studies reporting this outcome, reduced pain (number of participants with pain at the long term follow-up: 10/35 versus 25/34; risk ratio (RR) 0.39, 95% confidence interval (CI) 0.22 to 0.68; 2 studies) and improved ankle dorsiflexion range of motion. However, it also led to a higher rate of mainly minor adverse events (49/201 versus 20/197; RR 2.30, 95% CI 1.49 to 3.56; 7 studies).During the immobilisation period after surgical fixation, commencing weight-bearing made a small improvement in ankle dorsiflexion range of motion (mean difference in the difference in range of motion compared with the non-fractured side at the long term follow-up 6.17%, 95% CI 0.14 to 12.20; 2 studies). Evidence from one small but potentially biased study (60 participants) showed that neurostimulation, an electrotherapy modality, may be beneficial in the short-term. There was little and inconclusive evidence on what type of support or immobilisation was the best. One study found no immobilisation improved ankle dorsiflexion and plantarflexion range of motion compared with cast immobilisation, but another showed using a backslab improved ankle dorsiflexion range of motion compared with using a bandage.Five studies investigated different rehabilitation interventions following the immobilisation period after either conservative or surgical orthopaedic management. There was no evidence of effect for stretching or manual therapy in addition to exercise, or exercise compared with usual care. One small study (14 participants) at a high risk of bias found reduced ankle swelling after non-thermal compared with thermal pulsed shortwave diathermy. There is limited evidence supporting early commencement of weight-bearing and the use of a removable type of immobilisation to allow exercise during the immobilisation period after surgical fixation. Because of the potential increased risk of adverse events, the patient's ability to comply with the use of a removable type of immobilisation to enable controlled exercise is essential. There is little evidence for rehabilitation interventions during the immobilisation period after conservative orthopaedic management and no evidence for stretching, manual therapy or exercise compared to usual care following the immobilisation period. Small, single studies showed that some electrotherapy modalities may be beneficial. More clinical trials that are well-designed and adequately-powered are required to strengthen current evidence.

A randomized controlled trial on the efficacy of intermittent and continuous traction for patients with knee osteoarthritis

Objective: To investigate the efficacy of intermittent and continuous traction in the treatment of knee osteoarthritis. Design: A randomized, controlled, observer-blind seven-week trial. Setting: Hospital-based outpatient practice. Subjects: Ninety-eight patients with stage 3 knee osteoarthritis according to Kellgren–Lawrence radiological rating scale. Interventions: All 98 patients were randomly assigned to three treatment groups, for three weeks (weekends excluded). The control group (n=30, mean age: 59.30±8.16) received hot pack and short wave diathermy; the intermittent group (n=30, mean age: 58.20±7.78) received hot pack, short wave diathermy and intermittent traction; and the continuous group (n=30, mean age: 57.97±9.53) received hot pack, short wave diathermy and continuous traction. Outcome measurements: The values of the Turkish version of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale, and knee passive range of motion were measured at baseline, three-week and seven-week follow-up. Results: Compared with baseline at weeks 3 and 7, all the outcome measures, except range of motion, were significantly reduced in all groups (all P≤0.001). In terms of the change data from baseline to week 3, both traction groups were significantly superior to the control in the WOMAC physical function scores. Considering the change data from baseline to week 7, both traction groups were significantly superior to the control in the pain scores, physical function and total scores, while only the continuous group was significantly better than the control in the stiffness scores (control: 1.17 ± 1.64; continuous: 2.38 ± 1.44) (P=0.014). Compared with baseline at weeks 3 and 7, range of motion values significantly increased in both traction groups (P<0.05) but not in the control (P>0.05). However, there were no significant differences among the three groups considering the change data from baseline to week 7 in range of motion values (P=0.300). Conclusions: Joint traction was found to be beneficial for the improvement of pain and physical function loss related to knee osteoarthritis.

Trends in the availability and usage of electrophysical agents in physiotherapy practices from 1990 to 2010: a review

Background: The use of electrophysical agents has a historically important role in physiotherapy practice. There are anecdotal reports that the availability and usage of electrotherapy modalities are declining, which may have implications for physiotherapy practice. The aim of this literature review was to provide scientific evidence on electrotherapy usage in the last 20 years by identifying trends in availability, use, and non-use of nine electrotherapeutic modalities in physiotherapy practices during 1990s and 2000s.Methods: Review of empirical studies published in the English language from 1990 to 2010 and identified through searching online bibliographic databases, which included: Medline/OvidSP, PubMed Central, CINAHL/EBSCOhost, ScienceDirect, Scopus, ISI Web of Science, and Google Scholar.Findings: In the last 20 years, ultrasound availability and usage show increasing trends in several countries. The availability and use of pulsed shortwave diathermy and laser have shown steady trends. Transcutaneous electrical nerve stimulation, interferential, and biofeedback availability and usage have shown increasing trends in the UK and decreasing trends in Australia and the Republic of Ireland. Trends of continuous shortwave diathermy availability and use are declining irrespective of the country of the study. The availability and usage of microwave diathermy and H-wave show steeply declining trends, while there is a sharp rise in their non-availability over the last several years.Conclusions: The availability and use of electrophysical agents have greatly changed in the last 20 years. Declining trends in the availability and usage along with increasing trend of non-availability of electrotherapy modalities may have implications for electrotherapy education, training, and practice in the coming years.

Comparison of the Efficacy of Transcutaneous Electrical Nerve Stimulation, Interferential Currents, and Shortwave Diathermy in Knee Osteoarthritis: A Double-Blind, Randomized, Controlled, Multicenter Study

Atamaz FC, Durmaz B, Baydar M, Demircioglu OY, Iyiyapici A, Kuran B, Oncel S, Sendur OF. Comparison of the efficacy of transcutaneous electrical nerve stimulation, interferential currents, and shortwave diathermy in knee osteoarthritis: a double-blind, randomized, controlled, multicenter study. ObjectiveTo compare the effectiveness of transcutaneous electrical nerve stimulation (TENS), interferential currents (IFCs), and shortwave diathermy (SWD) against each other and sham intervention with exercise training and education as a multimodal package. DesignA double-blind, randomized, controlled, multicenter trial. SettingDepartments of physical medicine and rehabilitation in 4 centers. ParticipantsPatients (N=203) with knee osteoarthritis (OA). InterventionsThe patients were randomized by the principal center into the following 6 treatment groups: TENS sham, TENS, IFCs sham, IFCs, SWD sham, and SWD. All interventions were applied 5 times a week for 3 weeks. In addition, exercises and an education program were given. The exercises were carried out as part of a home-based training program after 3 weeks' supervised group exercise. Main Outcome MeasuresPrimary outcome was a visual analog scale (0–100mm) to assess knee pain. Other outcome measures were time to walk a distance of 15m, range of motion, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Nottingham Health Profile, and paracetamol intake (in grams). ResultsWe found a significant decrease in all assessment parameters (P<.05), without a significant difference among the groups except WOMAC stiffness score and range of motion. However, the intake of paracetamol was significantly lower in each treatment group when compared with the sham groups at 3 months (P<.05). Also, the patients in the IFCs group used a lower amount of paracetamol at 6 months (P<.05) in comparison with the IFCs sham group. ConclusionsAlthough all groups showed significant improvements, we can suggest that the use of physical therapy agents in knee OA provided additional benefits in improving pain because paracetamol intake was significantly higher in the patients who were treated with 3 sham interventions in addition to exercise and education.