Continuous short-wave (radio-frequency) diathermy

Effects of 27.12 MHz short-waves on fibroblast cell culture and K-562 and ML-1 neoplastic cell lines

Objectives

This study aims to assess the effect of short-wave therapy (SWT) devices emitting radiofrequency (RF) waves on the proliferation rates of fibroblasts and neoplastic cells.

Patients and methods

In this experimental study, fibroblasts cultured from sternal mesenchymal cells of a bypass surgery patient were enriched using stem cell techniques between January 2004 and February 2004. The K-562 and ML-1 neoplastic cell lines were prepared for analysis. Fibroblasts and neoplastic cell lines were exposed to 27.12 MHz short-waves at different energy levels. Continuous short-wave (CSW) was applied at 200 W power, and pulsed short-wave (PSW) was applied at three different mean powers: 1.6 W (PSW-1), 14.9 W (PSW-2), and 54 W (PSW-3). Fibroblast colonies were counted using inverted microscopy, and neoplastic cell proliferation rates were measured using enzyme-linked immunosorbent assay. All short-wave-exposed cells were compared to the controls with no exposure.

Results

Short-waves increased the number of fibroblast colonies three- to four-fold across all power levels (1.6 W, 14.9 W, 54 W, and 200 W). They significantly increased K-562 cell proliferation only at 1.6 W and 54 W power levels (p=0.044 and p=0.004, respectively). In contrast, there was no significant increase in ML-1 cell proliferation at any power level tested (p>0.05).

Conclusion

This study found that short-waves can boost fibroblast proliferation, potentially aiding tendon healing. However, it also had unpredictable proliferative effects on K-562 cells, as an inconsistent correlation with energy levels was observed. The ML-1 cells were not affected by short-waves, suggesting variability in tumor biology. These findings emphasize the need for precise dosing and personalized treatment strategies when using SWT devices.

The influence of near-infrared therapy on arteriovenous fistula patency in haemodialysis patients: A multicentre, randomised, controlled clinical trial

BACKGROUND

Arteriovenous fistula (AVF) is the preferred vascular access for patients undergoing haemodialysis (HD). AVF malfunction remains a major clinical problem and is a significant independent risk factor for death. Although far-infrared (FIR) therapy has been shown to reduce complications and improve the patency rate of AVFs in various studies, it has been cautiously recommended by the Kidney Disease Outcome Quality Initiative (KDOQI) guidelines for AVF care due to insufficient evidence. Therefore, it is necessary to identify more effective methods for preventing AVF dysfunction. Many in vitro studies and few clinical studies have examined the effects of near-infrared (NIR) therapy on the vasculature. This study will examine the effects of NIR therapy on AVF.

METHODS

A randomised, controlled, open-label, multicentre trial will compare the effect of NIR on AVF patency after 1 year of therapy with that of a control group of patients with existing AVF. One group of patients received NIR treatment above their AVFs, whereas the control group received regular care. The primary outcome is the primary fistula patency rate within 12 months. In addition, acute changes in inflammatory, vasodilatory and haemodynamic parameters after a single treatment in the first 40 participants will be examined. This study was registered in the Clinical Trials Registry (ChiCTR2300071305) at https://register.clinicaltrials.gov/.

DISCUSSIONS

This study will explore the long-term and acute effects of NIR on AVFs. The study findings will provide information that can be used to develop new technical support for the prevention of AVF dysfunction in patients undergoing haemodialysis.

The Therapeutic Effect of Monopolar Radiofrequency Therapy on Urinary Symptoms and Sexual Function

Objectives: Stress urinary incontinence (SUI) negatively affects the quality of life and sexual function in women. This study aimed to evaluate the efficacy of radiofrequency (RF) therapy in reducing SUI symptoms and its impact on sexual function. Methods: Thirty-four women with SUI were enrolled and underwent a single RF treatment session using the Viveve® System (Viveve Medical Inc., USA) with parameters of 90 J/cm2 and 220 pulses per hour. Assessments at baseline and 6 months post treatment included perineal ultrasound and personal interviews to evaluate lower urinary tract symptoms and sexual function. Urodynamic studies, voiding diaries, and questionnaires such as the Female Sexual Function Index (FSFI), Overactive Bladder Symptom Score (OABSS), Urogenital Distress Inventory-6 (UDI-6), Incontinence Impact Questionnaire-7 (IIQ-7), and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) measured outcomes. Results: RF therapy significantly improved sexual function, with higher FSFI scores in all domains except pain at 6 months. SUI symptoms were significantly reduced, as indicated by improved scores on OABSS, UDI-6, IIQ-7, and ICIQ-SF, alongside better voiding diary results. Anatomical changes included reduced bladder neck mobility, decreased vaginal width, and a reduced rotation angle of the proximal urethra. Conclusions: RF therapy is effective and safe for treating mild to moderate SUI and enhances sexual function, potentially due to changes in vaginal topography. These results suggest RF therapy as a viable non-surgical option for managing SUI and improving sexual health.

Novel Approach to Facial Rejuvenation by Treating Cutaneous and Soft Tissue for Wrinkles Reduction: First Experience from Multicenter Clinical Trial

Background: Facial aging is determined by skin quality and the condition of underlying muscles, which contribute to the overall appearance by lifting heavy facial structures. Objective: This study aims to assess the safety and effectiveness of the novel radiofrequency (RF) and high-intensity facial muscle stimulation (HIFES) technology for treating wrinkles by facial tissue remodeling. Methods: This trial assessed the 3-month data of 24 subjects seeking facial wrinkles treatment. All subjects received four treatments, with a device utilizing RF and HIFES. The evaluation included a two-dimensional photographs assessment according to the Fitzpatrick Wrinkle and Elastosis Scale (FWES) and a three-dimensional (3D) photograph analysis for facial appearance. Therapy comfort and subject satisfaction were assessed. Results: Based on the data of 24 subjects (56.5 ± 2.0 years, skin types I-IV), the significant improvement increased up to 3 months (-2.3 points, p < 0.001) post-treatment. 3D photographs analysis documented notable cutaneous and structural rejuvenation and coincided with FWES evaluation, underlining the positive subjective appreciation of the results with 20.4% average wrinkle reduction at 1 month, further increasing to 36.6% wrinkle reduction at 3 months. Conclusion: Documented by both subjective and objective evaluation tools, the RF and HIFES procedure for facial rejuvenation was found to be effective for treatment of wrinkles and skin texture. ClinicalTrials.gov Identifier: NCT05519124.

Efficacy of ultrasound versus short wave diathermy in the treatment of chronic low back pain in patients with lumbar disk herniation: a prospective randomized control study

BACKGROUND

Lumbar disk herniation (LDH) is a cause of chronic low back pain (CLBP) treated using physical therapy (PT), including exercise and physical modalities such as ultrasound (US) and short wave diathermy (SWD). Despite the use of US and SWD, there is inconclusive evidence on their efficacy. The aim of this study was to investigate the efficacy of US and SWD in the treatment of CLBP in patients with LDH.

METHODS

A prospective randomized control clinical study. Individuals with radicular CLBP and LDH on magnetic resonance imaging, presenting to the Physical and Rehabilitation Medicine Department were randomized into 3 treatment groups. All participants received 10 sessions of hotpack, transcutaneous nerve stimulation (TENS) and therapeutic exercises. In addition, Group 1 received 10 sessions of therapeutic US (1 MHz, 1.5W/cm2, 10 min), Group 2 SWD (27.12 MHz, wavelength 11.06 m, induction technique, 20 min) to the lower back. Group 3 (control group) received hotpack, TENS and therapeutic exercises alone. Visual analogue scale (VAS) for LBP, Modified Oswestry Disability Index (MODI) and Short Form 36 (SF-36) were evaluated pre and post treatment and at one and three months follow up.

RESULTS

In all groups, VAS for LBP and MODI improved with treatment and at the one and three month follow up (p < 0.001). In Groups 1 and 2, MODI scores continued to reduce at 1 and 3 months (p < 0.001 and p = 0.012 respectively). SF-36 physical, social function and pain parameters reduced in all groups (p < 0.05). Role limitation due to physical and emotional problems, emotional well-being, vitality and mental health improved in Groups 1 and 2 (p < 0.05).

CONCLUSIONS

Deep heating agents can be used as part of the physical therapy for CLBP in those with LDH with positive mid-term effects.

TRIAL REGISTRATION

NCT03835182, 02/04/2019.

Efficacy and safety of ultra-short wave diathermy on COVID-19 pneumonia: a pioneering study

Background

The ultra-short wave diathermy (USWD) is widely used to ameliorate inflammation of bacterial pneumonia, however, for COVID-19 pneumonia, USWD still needs to be verified. This study aimed to investigate the efficacy and safety of USWD in COVID-19 pneumonia patients.

Methods

This was a single-center, evaluator-blinded, randomized controlled trial. Moderate and severe COVID-19 patients were recruited between 18 February and 20 April 2020. Participants were randomly allocated to receive USWD + standard medical treatment (USWD group) or standard medical treatment alone (control group). The negative conversion rate of SARS-CoV-2 and Systemic Inflammatory Response Scale (SIRS) on days 7, 14, 21, and 28 were assessed as primary outcomes. Secondary outcomes included time to clinical recovery, the 7-point ordinal scale, and adverse events.

Results

Fifty patients were randomized (USWD, 25; control, 25), which included 22 males (44.0%) and 28 females (56.0%) with a mean (SD) age of 53 ± 10.69. The rates of SARS-CoV-2 negative conversion on day 7 (p = 0.066), day 14 (p = 0.239), day 21 (p = 0.269), and day 28 (p = 0.490) were insignificant. However, systemic inflammation by SIRS was ameliorated with significance on day 7 (p = 0.030), day 14 (p = 0.002), day 21 (p = 0.003), and day 28 (p = 0.011). Time to clinical recovery (USWD 36.84 ± 9.93 vs. control 43.56 ± 12.15, p = 0.037) was significantly shortened with a between-group difference of 6.72 ± 3.14 days. 7-point ordinal scale on days 21 and 28 showed significance (p = 0.002, 0.003), whereas the difference on days 7 and 14 was insignificant (p = 0.524, 0.108). In addition, artificial intelligence-assisted CT analysis showed a greater decrease in the infection volume in the USWD group, without significant between-group differences. No treatment-associated adverse events or worsening of pulmonary fibrosis were observed in either group.

Conclusion

Among patients with moderate and severe COVID-19 pneumonia, USWD added to standard medical treatment could ameliorate systemic inflammation and shorten the duration of hospitalization without causing any adverse effects.Clinical Trial Registration: chictr.org.cn, identifier ChiCTR2000029972.

Immediate analgesic effect of two modes of short-wave diathermy application in chronic low back pain: study protocol for a randomized controlled trial

The aim of this study is to evaluate and compare the immediate analgesic effects of two applications of short-wave diathermy (SWD) in individuals with chronic low back pain. Randomized, controlled, double-blind clinical trial. A total of 159 participants with chronic low back pain will be randomized in three groups: pulsed mode SWD, continuous mode SWD and placebo. SWD will be applied only once for 30 min. The primary outcomes: intensity and quality of pain. Secondary outcomes: depression and anxiety; perception of global improvement; patient satisfaction; disability and influence of psychosocial factors, strength of the lower limbs and the mobility of the posterior chain. Patients will be evaluated before and after the session and 1 week after. Trial registration number: RBR-2k58f5h Brazilian Registry of Clinical Trials (ReBEC).

Efficacy and safety of short-wave diathermy treatment for moderate COVID-19 patients: a prospective, double-blind, randomized controlled clinical study

BACKGROUND

Millions of human beings have suffered in the epidemic of Coronavirus disease 2019 (COVID-19), but until now the effective treatment methods have been limited.

AIM

This study aimed to evaluate the efficacy and safety of short-wave diathermy (SWD) treatment for moderate COVID-19 patients.

DESIGN

A prospective, double-blind, randomized controlled clinical study.

SETTING

Inpatients Unit of a COVID-19 specialized hospital.

POPULATION

Forty-two patients with moderate COVID-19 were randomly allocated at a 2:1 ratio to two groups: the SWD group and the control group.

METHODS

Participants of the SWD group received SWD treatment, and participants of the control group received placebo SWD treatment for one session per day, 10 minutes per session, for no more than 14 days. Both groups were given standard care treatment. Primary outcome was the rate of clinical improvement according to a seven-category ordinal scale. Secondary outcomes included the rate of computed tomography (CT) improvement and the rate of potential adverse events.

RESULTS

Clinical improvement occurred in 92.6% of patients in the SWD group by day 14 compared with 69.2% of patients in the control group (P=0.001). The Cox model indicated that the SWD group had a higher clinical improvement probability than the control group (hazard ratio: 3.045; 95% CI: 1.391-6.666; P=0.005). Similarly, CT improvement occurred in 85.2% of patients in the SWD group and 46.2% of patients in the control group respectively by day 14 (P=0.001). The Cox model indicated SWD group had a higher CT improvement probability than control group (hazard ratio: 3.720; 95% CI: 1.486-9.311; P=0.005). There was no significant difference in adverse events between the SWD group and the control group (2 of 27 [7.4%] SWD vs. 1 of 13 [7.7%] control, P=1.000), the most frequent of which were headache (1 of 27 [3.7%] SWD vs. 1 of 13 [7.7%] control patients) and dizziness (1 of 27 [3.7%] SWD vs. 0 of 13 [0%] control patients).

CONCLUSIONS

SWD is a valid and reliable adjuvant therapy with a favorable safety profile for moderate COVID-19 patients.

CLINICAL REHABILITATION IMPACT

Clinically relevant information is lacking regarding the efficacy and safety of SWD for patients with COVID-19. This study provides the first evidence that SWD is a promising adjuvant therapy for COVID-19.

Changes in serum inflammatory factors in acute gouty arthritis patients treated using ultrashort wave combined with loxoprofen sodium

Objectives

To study the effect of ultrashort wave combined with loxoprofen sodium on serum inflammatory factors in patients with acute gouty arthritis.

Methods

Records of patients with acute gouty arthritis who were treated in The Fourth Hospital of Changsha from May 2018 to September 2020, were reviewed. Of them, 77 cases were selected and divided into two groups based on the received treatment. The control group (n=39) was treated with loxoprofen sodium, and the treatment group (n=38) was treated with an ultrashort wave combined with loxoprofen sodium, for 10 continuous days. The clinical efficacy of the treatment in two groups was analyzed.

Results

After treatment, the quality of life of patients in both groups was improved (P < 0.05), but there was no significant difference in the degree of improvement between the two groups (P > 0.05). After treatment, the VAS score of the treatment group was lower than that of the control group (P < 0.05), the improvement of symptoms and signs of the treatment group was better than that of the control group (P < 0.05). Serum CRP and ESR levels in the treatment group were lower than those in the control group (P < 0.05), and the serum IL-1 β, IL-8, TNF-a and MMP-3 levels of the treatment group were lower than those of the control group (P < 0.05). The total effective rate of the treatment group (94.87%) was higher than that of the control group (87.18%), the difference was statistically significant (P < 0.05). No adverse reactions occurred in all patients during the treatment.

Conclusion

An ultrashort wave combined with loxoprofen sodium in the treatment of acute gouty arthritis can reduce the inflammatory reaction, improve the degree of joint pain and swelling, improve the curative effect, and do not increase the adverse reactions. The results may be related to the regulation of IL-1 β, IL-8, TNF-a and MMP-3.

Indirect Structural Muscle Injuries of Lower Limb: Rehabilitation and Therapeutic Exercise

Muscle injuries are the most common trauma in team and individual sports. The muscles most frequently affected are those of the lower limb, and in particular hamstrings, adductors, rectus femoris and calf muscles. Although several scientific studies have tried to propose different rehabilitation protocols, still too often the real rehabilitation process is not based on scientific knowledge, especially in non-elite athletes. Moreover, the growing use of physical and instrumental therapies has made it increasingly difficult to understand what can be truly effective. Therefore, the aim of the present paper is to review proposed therapeutic algorithms for muscle injuries, proposing a concise and practical summary. Following a three-phase rehabilitation protocol, this review aims to describe the conservative treatment of indirect structural muscle injuries, which are the more routinely found and more challenging type. For each phase, until return to training and return to sport are completed, the functional goal, the most appropriate practitioner, and the best possible treatment according to current evidence are expressed. Finally, the last section is focused on the specific exercise rehabilitation for the four main muscle groups with a structured explanatory timetable.

Simultaneous Application of High-Intensity Focused Electromagnetic and Synchronized Radiofrequency for Fat Disruption: Histological and Electron Microscopy Porcine Model Study

BACKGROUND

Radiofrequency (RF) and high-intensity focused electromagnetic (HIFEM) technologies are used for noninvasive body shaping as standalone modalities.

OBJECTIVE

To examine the effects of novel synchronized RF and HIFEM on subcutaneous adipose tissue in a porcine animal model.

MATERIALS AND METHODS

Seven large white pigs aged 6 months received 3 abdominal treatments of simultaneous application of synchronized RF and HIFEM (30 minutes, once per week). Punch biopsies of treated and control subcutaneous tissue were collected at the baseline, 4 days, 2 weeks, 1 month, and 2 months. Specimens were examined by light and scanning electron microscopy. Adipocyte volume was analyzed. Fat tissue temperature was measured in situ (fiber optic probes) and superficially (thermal imager).

RESULTS

Fat layer was heated to temperatures of 42 to 45°C. Signs of fat apoptosis (shape alternations and pyknotic nuclei) appeared at day 4 and peaked between 2 weeks and 1 month. Adipocyte volume decreased significantly (p < .001) by 31.1% at 2 weeks, 1 month (-23.6%), and 2 months (-22.0%). Control samples showed healthy adipocytes. Scanning electron microscopy micrographs corroborated histology findings, showing flattened, volume-depleted and disrupted adipocytes.

CONCLUSION

Synchronized RF with HIFEM procedure resulted in a significant and sustained fat reduction with no adverse events.

Coplanar arrangement of shortwave diathermy is the most effective in skin temperature change: A randomized crossover trial

INTRODUCTION

Continuous shortwave diathermy (CSWD) efficacy relies on change in temperature, which had been evaluated previously. However, the studies are not comparable enough, consequently the primary goal of this study was to analyze which SWD capacitive technique arrangement is the most effective in skin temperature change.

METHOD

A randomized, single-blinded crossover trial conducted in a university research laboratory. Twenty young healthy male subjects were randomly allocated using a website to receive 20 min of CSWD application to the anterior aspect of the thigh through coplanar, contraplanar and longitudinal arrangement. Skin temperature was collected under the proximal electrode and at the thigh center over 25 min after electrodes removal, using an infrared thermography camera.

RESULTS

There were two losses to follow up, remaining 18 subjects for analysis (age = 21.4 ± 2.09 years, BMI = 23.6 ± 2.46 kg/m²). Under the electrode all arrangements achieved vigorous heating (coplanar = 7.9 ± 1.76 °C; contraplanar = 6.52 ± 2.68 °C; longitudinal = 7.46 ± 1.8 °C) immediately after electrodes removal and temperature decreased with a similar rate across arrangements. At the thigh center, coplanar arrangement achieved mild heating (1-2 °C) until 17 min after electrodes removal; meanwhile, the other arrangements did not increase temperature sufficiently for post intervention therapeutic effects. No unintended effect was detected.

CONCLUSIONS

Coplanar arrangement increased skin temperature the most, heated the greatest area, and had the slowest temperature decay. If the body part accommodates any of the capacitive technique arrangements, coplanar should be used to treat superficial tissues.

Short-wave diathermy in the clinical management of musculoskeletal disorders: a pilot observational study

Musculoskeletal disorders are the most common cause of pain and functional limitation in the general population. The study aim was  to evaluate short-wave diathermy (SWD) effects on pain and quality of life in people with musculoskeletal disorders. Eighty participants (31 men, mean age 56 ± 12.49 years) were enrolled, recruiting from outpatient clinics at the Rehabilitation Unit, University Hospital, Padova. Inclusion criteria were pain lasting more than 15 days, pain visual analog scale (VAS) score higher than 50/100 mm, and a diagnosis of osteoarthritis, neck/back pain, or tendinopathies. All participants underwent ten sessions of percutaneous SWD, 3 times/week. Each session lasted 15-20 min, with frequencies of 4 or 8 MHz and heat intensity between 40 and 60 W. Outcomes were assessed before and after treatment. Primary outcome was pain reduction, evaluated by short form McGill pain questionnaire, which includes VAS and present pain intensity (PPI). Secondary outcome was improvement in social and work-related activity limitations. Participants were grouped based on classification of pain [nociceptive and neuropathic pain (group A) vs nociceptive only (group B)]. VAS and PPI improved significantly (p < 0.01). No difference in pain reduction (VAS and PPI) emerged between the groups. Limitations due to pain in work-related and non-work-related activities decreased (p < 0.01); use of pain medications was reduced at T1 vs T0 (p < 0.01). Our results suggest that SWD is effective in reducing musculoskeletal pain in the short term, providing relief and improving quality of life.

Emerging medical applications based on non-ionizing electromagnetic fields from 0 Hz to 10 THz

The potential for using non-ionizing electromagnetic fields (EMF; at frequencies from 0 Hz up to the THz range) for medical purposes has been of interest since many decades. A number of established and familiar methods are in use all over the world. This review, however, provides an overview of applications that already play some clinical role or are in earlier stages of development. The covered methods include modalities used for bone healing, cancer treatment, neurological conditions, and diathermy. In addition, certain other potential clinical areas are touched upon. Most of the reviewed technologies deal with therapy, whereas just a few diagnostic approaches are mentioned. None of the discussed methods are having such a strong impact in their field of use that they would be expected to replace conventional methods. Partly this is due to a knowledge base that lacks mechanistic explanations for EMF effects at low-intensity levels, which often are used in the applications. Thus, the possible optimal use of EMF approaches is restricted. Other reasons for the limited impact include a scarcity of well-performed randomized clinical trials that convincingly show the efficacy of the methods and that standardized user protocols are mostly lacking. Presently, it seems that some EMF-based methods can have a niche role in treatment and diagnostics of certain conditions, mostly as a complement to or in combination with other, more established, methods. Further development and a stronger impact of these technologies need a better understanding of the interaction mechanisms between EMF and biological systems at lower intensity levels. The importance of the different physical parameters of the EMF exposure needs also further investigations.

KNEE PROPRIOCEPTION MAY BE ALTERED BY TREATMENT IN ATHLETES SUFFERING FROM DELAYED ONSET MUSCLE SORENESS

Delayed onset muscle soreness (DOMS) is a very common musculoskeletal problem in athletes involved in extreme competitions. The aim of this study is to compare the effect of diathermy, sham diathermy and massage on the knee proprioception of athletes treated for DOMS. Forty athletes were enrolled after the second day of a demanding ski mountaineering race. They were randomly assigned to four groups: no treatment [Formula: see text], massage [Formula: see text], diathermy [Formula: see text], and sham diathermy [Formula: see text]. The knee reposition error was measured after the treatments in order to assess knee proprioception. Significant differences between the diathermy and sham diathermy groups were found ([Formula: see text]) with an absolute effect size of [Formula: see text]. No other significant differences were found among groups. This means that diathermy has a negative impact on joint proprioception and can be explained by the spindle desensitization consequent to deeper tissue heating. This information can be important in the DOMS management of athletes, since an altered proprioception may interfere with the athlete’s performance and can increase the risk of injury.

Italian consensus conference on guidelines for conservative treatment on lower limb muscle injuries in athlete

Provide the state of the art concerning (1) biology and aetiology, (2) classification, (3) clinical assessment and (4) conservative treatment of lower limb muscle injuries (MI) in athletes. Seventy international experts with different medical backgrounds participated in the consensus conference. They discussed and approved a consensus composed of four sections which are presented in these documents. This paper represents a synthesis of the consensus conference, the following four sections are discussed: (i) The biology and aetiology of MIs. A definition of MI was formulated and some key points concerning physiology and pathogenesis of MIs were discussed. (ii) The MI classification. A classification of MIs was proposed. (iii) The MI clinical assessment, in which were discussed anamnesis, inspection and clinical examination and are provided the relative guidelines. (iv) The MI conservative treatment, in which are provided the guidelines for conservative treatment based on the severity of the lesion. Furthermore, instrumental therapy and pharmacological treatment were discussed. Knowledge of the aetiology and biology of MIs is an essential prerequisite in order to plan and conduct a rehabilitation plan. Another important aspect is the use of a rational MI classification on prognostic values. We propose a classification based on radiological investigations performed by ultrasonography and MRI strongly linked to prognostic factors. Furthermore, the consensus conference results will able to provide fundamental guidelines for diagnostic and rehabilitation practice, also considering instrumental therapy and pharmacological treatment of MI. Expert opinion, level IV.

The Effects of Extracorporeal Shock Wave Therapy in Patients with Coccydynia: A Randomized Controlled Trial

Coccydynia is pain in the coccygeal region, and usually treated conservatively. Extracorporeal shock wave therapy (ESWT) was incorporated as non-invasive treatment of many musculoskeletal conditions. However, the effects of ESWT on coccydynia are less discussed. The purpose of this study is to evaluate the effects of ESWT on the outcomes of coccydynia. Patients were allocated to ESWT (n = 20) or physical modality (SIT) group (n = 21) randomly, and received total treatment duration of 4 weeks. The visual analog scale (VAS), Oswestry disability index (ODI), and self-reported satisfaction score were used to assess treatment effects. The VAS and ODI scores were significantly decreased after treatment in both groups, and the decrease in the VAS score was significantly greater in the ESWT group. The mean proportional changes in the ODI scores were greater in the ESWT group than in the SIT group, but the between-group difference was not statistically significant. The patients in the ESWT group had significantly higher subjective satisfaction scores than SIT group. We concluded that ESWT is more effective and satisfactory in reducing discomfort and disability caused by coccydynia than the use of physical modalities. Thus, ESWT is recommended as an alternative treatment option for patients with coccydynia.

Noninvasive and alternative management of chronic low back pain (efficacy and outcomes)

OBJECTIVES

The goal of this article is to provide a thorough literature review of available noninvasive and alternative treatment options for chronic low back pain. In particular, the efficacy of each therapy is evaluated and pertinent outcomes are described.

MATERIALS AND METHODS

A comprehensive search for available literature was done through PubMed and Cochrane data base for topics discussed in this paper.

RESULTS

Relevant current and past references were reviewed and presented to reflect the efficacy of each therapy and related outcomes.

CONCLUSIONS

There are a wide variety of noninvasive and alternative therapies for the treatment of chronic low back pain. Those with the strongest evidence in the literature for good efficacy and outcomes include exercise therapy with supervised physical therapy, multidisciplinary biopsychosocial rehabilitation, and acupuncture. Therapies with fair evidence or moderately supported by literature include yoga, back schools, thermal modalities, acupressure, and cognitive-behavioral therapy. Those therapies with poor evidence or little to no literature support include manipulation, transcutaneous electrical nerve stimulation, low-level laser therapy, reflexology, biofeedback, progressive relaxation, hypnosis, and aromatherapy. Providers delivering care for patients with chronic low back pain must carefully evaluate these available treatment options related to their efficacy or lack thereof as well as relevant outcomes.

Muscle heating with Megapulse II shortwave diathermy and ReBound diathermy

CONTEXT

A new continuous diathermy called ReBound recently has been introduced. Its effectiveness as a heating modality is unknown.

OBJECTIVE

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.

DESIGN

Crossover study.

SETTING

University research laboratory.

PATIENTS OR OTHER PARTICIPANTS

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).

INTERVENTION(S)

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.

MAIN OUTCOME MEASURE(S)

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.

RESULTS

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).

CONCLUSIONS

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.

Effects of linear-polarized near-infrared light irradiation on chronic pain

In order to study the efficacy of linear-polarized near-infrared light irradiation (LPNIR) on relieving chronic pain in conjunction with nerve block (NB) or local block (LB), a 3-week prospective, randomized, double-blind, controlled study was conducted to evaluate the pre- and post-therapy pain intensity. Visual analogue scales (VASs) were measured in all patients before and 6 months after therapy visiting the pain clinic during the period of August 2007 to January 2008. A total of 52 patients with either shoulder periarthritis or myofascial pain syndrome or lateral epicondylitis were randomly assigned into two groups by drawing lots. Patients in Group I were treated with NB or LB plus LPNIR; Group II patients, for their part, were treated with the same procedures as in Group I, but not using LPNIR. In both groups, the pain intensity (VAS score) decreased significantly immediately after therapy as compared to therapy. There was a significant difference between the test and control groups immediately after therapy (P < 0.05), while no effect 6 months later. No side effects were observed. It is concluded that LPNIR is an effective and safe modality to treat various chronic pains, which has synergic effects with NB or LB.

The application of infrared thermography in the assessment of patients with coccygodynia before and after manual therapy combined with diathermy

OBJECTIVE

This study examines the potential usefulness of a novel thermal imaging technique in the assessment of local physiologic responses before and after conservative therapies for coccygodynia.

METHODS

Patients with coccygodynia were selected on the basis of detailed history taking, clinical examination, and dynamic series radiography. They underwent therapeutic modalities consisting of 6 to 8 sessions of manual medicine treatments (massage of the levators followed by Maigne's manipulative technique) and external physiotherapy (short-wave diathermy) 3 times a week for 8 weeks. We performed the assessments with numeric pain rating scale (NPRS) and infrared thermography (IRT) before treatment and at 12 weeks.

RESULTS

A total of 53 patients (6 males and 47 females) ranging from 18 to 71 years of age and clinically diagnosed with coccygodynia received the full course of therapy and assessments. There were significant differences in both NPRS and surface temperature obtained by IRT in the 12-week follow-up (P < .05). The correlation between NPRS improvement and temperature decrement was significantly high (r = 0.67, P < .01).

CONCLUSIONS

The study shows that IRT can objectively show the decrement of surface temperatures correlating with changes in subjective pain intensity after treatment of coccygodynia. With the advantages of being painless, noninvasive, and easy to repeat, IRT appears to be useful as a quantifiable tool for monitoring the dynamics of the disease activity in coccygodynia.

A comparison of two different intra-articular hyaluronan drugs and physical therapy in the management of knee osteoarthritis

The aim of this study was to compare the effects of physical therapy agents (PTA) and two different intra-articular hyaluronan drugs (sodium hyaluronate (NaHA) and hylan G-F 20) on knee osteoarthritis (OA). The randomised, single-blind study, with 12 months of follow-up, was performed on 80 patients diagnosed as knee OA. The patients were randomly divided into two treatment groups: patients in group 1 were given weekly intra-articular hyaluronan treatment which consisted of either hylan G-F 20 or NaHA during the first 3 weeks and in the sixth month; PTA was applied to each patient in group 2 five times a week for 3 weeks with a series of infrared, short-wave diathermy-pulsed patterns and interferential therapy. Clinical assessments for each patient were made at 1, 3, 6, 9 and 12 months using the following measures: spontaneous pain, pain at rest, pain at night, pain on touch, pain on movement, 15 m walking time, range of motion, short form 36 (SF-36), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) global assessment. There was significant improvement in all variables measured in both groups during the follow-up except the WOMAC-stiffness and range of the motion. The improvement of pain (at night, at rest, SF-36) and SF-36 social functioning subscales was greater in the PTA group. Consequently, in the subgroup analyses, there was no difference between PTA and hylan groups for this improvement. In the comparison of two drugs, the reduction of pain on touch and WOMAC-function was greater in hylan group than that of NaHA. No serious local or systemic effects were observed following injections. Although all patients had improvement, PTA was superior to hyaluronan group for no activity-related pain and functional performance. On the other hand, this study supports the preferential use of hylan over NaHA in patients with knee OA.

A placebo controlled double blind trial to evaluate the effectiveness of pulsed short wave therapy for osteoarthritic hip and knee pain

The aim of this study was to investigate the effectiveness of pulsed short wave (PSW) in the relief of pain in osteoarthritis of the hip and knee. Ninety-two patients, mean age 63 years, (34 men and 58 women) were randomly allocated to one of three groups: (1) Active PSW, using the dosage found in a pilot study to be non-significantly most effective, (2) Placebo PSW, (3) No treatment control group. Nine sessions of treatment were provided over a 3-week period, each application lasting for 15 min. The machine was modified by the manufacturers so that the therapist was able to administer the treatment and carry out assessments without being aware of the treatment allocation. Outcome measures included sensory and affective pain diary reports averaged over days and weeks, self-reported benefit and the General Health Questionnaire. Analysis of variance with repeated measures over time was used to find out if the active treatment had a specific effect, incremental to the placebo effect. There were no significant differences between the active and placebo groups over time. According to the pain diary reports, both active and placebo groups tended to improve slightly during treatment, but worsened after its withdrawal. Patients who were given the placebo application tended to report more benefit than those who had the active treatment, although this did not quite reach statistical significance (P < 0.06). Patients who were not on a waiting list for surgery did significantly better over time than those who were (P < 0.03). There were no significant differences between the groups over time for the other outcome variables. Any treatment effect on this patient population appears to have been largely placebo-mediated. No evidence was found therefore for the specific effectiveness of PSW for treatment of osteoarthritic hip or knee pain.