1
|
Souto LR, De Oliveira Silva D, Pazzinatto MF, Siqueira MS, Moreira RFC, Serrão FV. Are adjunct treatments effective in improving pain and function when added to exercise therapy in people with patellofemoral pain? A systematic review with meta-analysis and appraisal of the quality of interventions. Br J Sports Med 2024; 58:792-804. [PMID: 38889956 DOI: 10.1136/bjsports-2024-108145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVE To compare the effectiveness of adjunct treatments combined with exercise to exercise alone in people with patellofemoral pain (PFP) and explore the quality of intervention descriptions in randomised controlled trials (RCTs). DESIGN Systematic review. DATA SOURCES Seven databases were searched in November 2023. ELIGIBILITY RCTs that evaluated the effectiveness of any adjunct treatment combined with exercise to exercise alone on self-reported pain and function in people with PFP. RESULTS We included 45 RCTs (2023 participants), with 25 RCTs (1050 participants) contributing to meta-analyses. Pooled analysis indicated very low-certainty evidence that neuromuscular electrical stimulation or monopolar dielectric diathermy combined with exercise leads to small and large improvements in self-reported pain when compared with exercise alone (standardised mean difference (95% CI)=-0.27 (-0.53 to -0.02) and -2.58 (-4.59 to -0.57), respectively) in the short-term. For self-reported pain and function, very low-certainty evidence indicates that knee taping, whole-body vibration, electromyographic biofeedback and knee brace combined with exercise do not differ from exercise alone. Interventions are poorly described in most RCTs, adjunct treatments scored on average 14/24 and exercise therapy 12/24 in the Template for Intervention Description and Replication checklist. CONCLUSION Neuromuscular electrical stimulation and monopolar dielectric diathermy combined with exercise seem to improve self-reported pain in people with PFP compared with exercise alone. Knee taping, whole-body vibration, electromyographic biofeedback and knee brace do not offer additional benefits to exercise alone. Most interventions are poorly described, which is detrimental to translating research knowledge into clinical practice. PROSPERO REGISTRATION NUMBER CRD42020197081.
Collapse
Affiliation(s)
- Larissa Rodrigues Souto
- Departament of Physiotherapy, Universidade Federal de Sao Carlos, Sao Carlos, São Paulo, Brazil
| | - Danilo De Oliveira Silva
- La Trobe Sport and Medicine Research Centre (LASEM), La Trobe University, Bundoora/Melbourne, Victoria, Australia
- Discipline of Physiotherapy, School of Allied Health, Human Services and Sport, LaTrobe University, Melbourne, Victoria, Australia
| | - Marcella F Pazzinatto
- La Trobe Sport and Medicine Research Centre (LASEM), La Trobe University, Bundoora/Melbourne, Victoria, Australia
| | - Malu Santos Siqueira
- Departament of Physiotherapy, Universidade Federal de Sao Carlos, Sao Carlos, São Paulo, Brazil
| | | | - Fábio Viadanna Serrão
- Departament of Physiotherapy, Universidade Federal de Sao Carlos, Sao Carlos, São Paulo, Brazil
| |
Collapse
|
2
|
Moretti L, Bizzoca D, Geronimo A, Abbaticchio AM, Moretti FL, Carlet A, Fischetti F, Moretti B. Targeting Adenosine Signalling in Knee Chondropathy: The Combined Action of Polydeoxyribonucleotide and Pulsed Electromagnetic Fields: A Current Concept Review. Int J Mol Sci 2023; 24:10090. [PMID: 37373237 DOI: 10.3390/ijms241210090] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/16/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
Chondropathy of the knee is one of the most frequent degenerative cartilage pathologies with advancing age. Scientific research has, in recent years, advanced new therapies that target adenosine A2 receptors, which play a significant role in human health against many disease states by activating different protective effects against cell sufferance and damage. Among these, it has been observed that intra-articular injections of polydeoxyribonucleotides (PDRN) and Pulsed Electromagnetic Fields (PEMF) can stimulate the adenosine signal, with significant regenerative and healing effects. This review aims to depict the role and therapeutic modulation of A2A receptors in knee chondropathy. Sixty articles aimed at providing data for our study were included in this review. The present paper highlights how intra-articular injections of PDRN create beneficial effects by reducing pain and improving functional clinical scores, thanks to their anti-inflammatory action and the important healing and regenerating power of the stimulation of cell growth, production of collagen, and the extracellular matrix. PEMF therapy is a valid option in the conservative treatment of different articular pathologies, including early OA, patellofemoral pain syndrome, spontaneous osteonecrosis of the knee (SONK), and in athletes. PEMF could also be used as a supporting therapy after an arthroscopic knee procedure total knee arthroplasty to reduce the post-operative inflammatory state. The proposal of new therapeutic approaches capable of targeting the adenosine signal, such as the intra-articular injection of PDRN and the use of PEMF, has shown excellent beneficial results compared to conventional treatments. These are presented as an extra weapon in the fight against knee chondropathy.
Collapse
Affiliation(s)
- Lorenzo Moretti
- Orthopaedics Unit-UOSD Vertebral Surgery, AOU Consorziale Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Davide Bizzoca
- Orthopaedics Unit-UOSD Vertebral Surgery, AOU Consorziale Policlinico, Piazza Giulio Cesare 11, 70124 Bari, Italy
- Ph.D. Course in Public Health, Clinical Medicine and Oncology, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Alessandro Geronimo
- Orthopaedics Unit, DiBraiN, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | | | - Francesco Luca Moretti
- National Centre for Chemicals, Cosmetic Products and Consumer Protection, National Institute of Health, 00161 Rome, Italy
| | - Arianna Carlet
- Orthopaedics Unit, DiBraiN, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Francesco Fischetti
- Departement DiBraiN, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Biagio Moretti
- Orthopaedics Unit, DiBraiN, University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari, Italy
| |
Collapse
|
3
|
Viti A, Panconi G, Guarducci S, Garfagnini S, Mondonico M, Bravi R, Minciacchi D. Modulation of Heart Rate Variability following PAP Ion Magnetic Induction Intervention in Subjects with Chronic Musculoskeletal Pain: A Pilot Randomized Controlled Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3934. [PMID: 36900946 PMCID: PMC10001461 DOI: 10.3390/ijerph20053934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/18/2023] [Accepted: 02/19/2023] [Indexed: 06/18/2023]
Abstract
Heart rate variability (HRV) analysis has emerged as a simple and non-invasive technique to indirectly evaluate the autonomic nervous system (ANS), and it is considered a sensible and advanced index of health status. Pulsed electromagnetic fields (PEMFs) are widely used in clinical settings for improving the health status of individuals with chronic musculoskeletal pain. The aim of the present single-blind, randomized, placebo-controlled parallel pilot study was to investigate the acute effect of a single session of PEMFs stimulation by a PAP ion magnetic induction (PAPIMI) device on ANS activity, as measured by HRV, in patients with chronic musculoskeletal pain, and compare such effect with that induced by a sham (control) PAPIMI inductor. Thirty-two patients were randomized into two groups: PAPIMI intervention (PAP) (n = 17) and sham PAPIMI intervention (SHAM-PAP) (n = 15). HRV was assessed before and following the interventions. The PAP group showed a significant increase in all values of the time-domain parameters (SDNN, RMSSD, NN50, and pNN50) and the HF component of HRV, suggesting a parasympathetic effect. In contrast, the SHAM-PAP group showed no significant differences in all HRV indices following the intervention. Preliminary findings suggested that PAPIMI inductor could influence ANS activity and provided initial evidence of the potential physiological response induced by the PAPIMI device.
Collapse
Affiliation(s)
- Antonio Viti
- Centro Fisioterapico Apuano, Via delle Contrade 242, 55047 Lucca, Italy
| | - Giulia Panconi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Sara Guarducci
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | | | - Mosè Mondonico
- Centro Fisioterapico Apuano, Via delle Contrade 242, 55047 Lucca, Italy
| | - Riccardo Bravi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Diego Minciacchi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| |
Collapse
|
4
|
Six Treatments Have Positive Effects at 3 Months for People With Patellofemoral Pain: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2022; 52:750-768. [PMID: 36070427 DOI: 10.2519/jospt.2022.11359] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE: To determine the effects of nonsurgical treatments on pain and function in people with patellofemoral pain (PFP). DESIGN: Systematic review with meta-analysis. LITERATURE SEARCH: We searched MEDLINE, Web of Science, and Scopus databases from their inception until May 2022 for interventional randomized controlled trials (RCTs) in people with PFP. STUDY SELECTION CRITERIA: We included RCTs that were scored ≥7 on the PEDro scale. DATA SYNTHESIS: We extracted homogenous pain and function data at short- (≤3 months), medium- (>3 to ≤12 months) and long-term (>12 months) follow-up. Interventions demonstrated primary efficacy if outcomes were superior to sham, placebo, or wait-and-see control. Interventions demonstrated secondary efficacy if outcomes were superior to an intervention with primary efficacy. RESULTS: We included 65 RCTs. Four interventions demonstrated short-term primary efficacy: knee-targeted exercise therapy for pain (standardized mean difference [SMD], 1.16; 95% CI: 0.66, 1.66) and function (SMD, 1.19; 95% CI: 0.51, 1.88), combined interventions for pain (SMD, 0.79; 95% CI: 0.26, 1.29) and function (SMD, 0.98; 95% CI: 0.47, 1.49), foot orthoses for global rating of change (OR = 4.31; 95% CI: 1.48, 12.56), and lower-quadrant manual therapy for function (SMD, 2.30; 95% CI: 1.60, 3.00). Two interventions demonstrated short-term secondary efficacy compared to knee-targeted exercise therapy: hip-and-knee-targeted exercise therapy for pain (SMD, 1.02; 95% CI: 0.58, 1.46) and function (SMD, 1.03; 95% CI: 0.61, 1.45), and knee-targeted exercise therapy and perineural dextrose injection for pain (SMD, 1.34; 95% CI: 0.72, 1.95) and function (SMD, 1.21; 95% CI: 0.60, 1.82). CONCLUSIONS: Six interventions had positive effects at 3 months for people with PFP, with no intervention adequately tested beyond this time point. J Orthop Sports Phys Ther 2022;52(11):750-768. Epub: 8 September 2022. doi:10.2519/jospt.2022.11359.
Collapse
|
5
|
Comparison of the Superiority of Quadriceps Strengthening Isometric and Isotonic Exercises with Respect to Pain, Quality of Life, and Functional Capacity of Patients with Chondromalacia Patellae. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.1075389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Purpose: This study aims to investigate the superiority of different exercise modalities, including isotonic and isometric strengthening for quadriceps, over each other and their effect on pain, quality of life and functional capacity in patients diagnosed with chondromalacia patellae (CMP).
Methods: This study was designed as a prospective study in 30 patients(15 patients in isometric, 15 patients in isotonic group) and 15 healthy volunteers aged 20–50 years who were diagnosed with CMP based on physical examination and magnetic resonance imaging and had pain complaints. Pain level was evaluated with Visual Analogue Scala (VAS), functional capacity with Lysholm scale, and quality of life with Short Form-36(SF-36). Q-angle, and thigh circumference were evaluated before and after exercise in all patients.
Results: In patients with CMP, there were significant differences in Q-angle, pain, functional capacity, and some subcomponents of the SF-36 quality of life after performing isometric or isotonic exercises compared with the control group (p0,05). In the evaluation of the isotonic and isometric exercise groups, there were no significant difference in the assessment of Q-angle, thigh circumference, pain, functional capacity, and quality of life of patients with CMP (p>0,05).
Conclusion: Isometric and isotonic quadriceps strengthening exercises are not superior to each other in terms of pain, functional capacity, and quality of life in CMP treatment.
Collapse
|
6
|
Moretti L, Bizzoca D, Giancaspro GA, Cassano GD, Moretti F, Setti S, Moretti B. Biophysical Stimulation in Athletes' Joint Degeneration: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111206. [PMID: 34833424 PMCID: PMC8619315 DOI: 10.3390/medicina57111206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 12/18/2022]
Abstract
Osteoarthritis (OA) is the most prevalent degenerative joint disease and the main cause of pain and disability in elderly people. OA currently represents a significant social health problem, since it affects 250 million individuals worldwide, mainly adults aged over 65. Although OA is a multifactorial disease, depending on both genetic and environmental factors, it is reported that joint degeneration has a higher prevalence in former athletes. Repetitive impact and loading, joint overuse and recurrent injuries followed by a rapid return to the sport might explain athletes' predisposition to joint articular degeneration. In recent years, however, big efforts have been made to improve the prevention and management of sports injuries and to speed up the athletes' return-to-sport. Biophysics is the study of biological processes and systems using physics-based methods or based on physical principles. Clinical biophysics has recently evolved as a medical branch that investigates the relationship between the human body and non-ionizing physical energy. A physical stimulus triggers a biological response by regulating specific intracellular pathways, thus acting as a drug. Preclinical and clinical trials have shown positive effects of biophysical stimulation on articular cartilage, subchondral bone and synovia. This review aims to assess the role of pulsed electromagnetic fields (PEMFs) and extracorporeal shockwave therapy (ESWT) in the prevention and treatment of joint degeneration in athletes.
Collapse
Affiliation(s)
- Lorenzo Moretti
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy; (L.M.); (G.A.G.); (G.D.C.); (B.M.)
| | - Davide Bizzoca
- PhD. Course in Public Health, Clinical Medicine and Oncology, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
- Correspondence:
| | - Giovanni Angelo Giancaspro
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy; (L.M.); (G.A.G.); (G.D.C.); (B.M.)
| | - Giuseppe Danilo Cassano
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy; (L.M.); (G.A.G.); (G.D.C.); (B.M.)
| | - Francesco Moretti
- National Center for Chemicals, Cosmetic Products and Consumer Protection, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy;
| | - Stefania Setti
- IGEA Spa-Clinical Biophysics, via Parmenide, 10/A, 41012 Carpi (Mo), Italy;
| | - Biagio Moretti
- Orthopaedics Unit, Department of Basic Medical Science, Neuroscience and Sensory Organs, School of Medicine, University of Bari “Aldo Moro”, AOU Consorziale Policlinico, 70124 Bari, Italy; (L.M.); (G.A.G.); (G.D.C.); (B.M.)
| |
Collapse
|
7
|
Paolucci T, Pezzi L, Centra AM, Giannandrea N, Bellomo RG, Saggini R. Electromagnetic Field Therapy: A Rehabilitative Perspective in the Management of Musculoskeletal Pain - A Systematic Review. J Pain Res 2020; 13:1385-1400. [PMID: 32606905 PMCID: PMC7297361 DOI: 10.2147/jpr.s231778] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 05/07/2020] [Indexed: 12/22/2022] Open
Abstract
Electromagnetic fields (EMFs) provide a non-invasive, safe, and easy method to treat pain with respect to musculoskeletal diseases. The purpose of this systematic review was to describe the use of electromagnetic therapy in the rehabilitation field by investigating the efficacy in acute and chronic pain in the musculoskeletal disorders. A database search was conducted using the following resources: PubMed, Cochrane, PEDro, SCOPUS, and WoS. The following MESH terms were used: [Electromagnetic field AND/OR Rehabilitation], [Electromagnetic field AND/OR Pain], [Pulsed Magnetic field AND/OR Rehabilitation] and [Pulsed Magnetic field AND/OR Pain], [Pulsed Electromagnetic field AND/OR Rehabilitation] and [Pulsed Electromagnetic field AND/OR Pain], per the guidelines of the PRISMA statement. Articles published between January 1, 2009 and December 31, 2018 were included as assessment of musculoskeletal pain conditions, randomized clinical trial including crossover and prospective design studies, full English text available, population age > 18 years; instead were excluded neurological randomized clinical trials, transcranial magnetic stimulation application, neuropathic pain, animal/in vitro studies, and articles without English abstract or English full text. Three independent investigators (AMC, NG, and LP) retrieved all the information. Twenty-one RTC (N=21) were considered for the inclusion and exclusion criteria. The results showed as pulsed magnetic fields at low intensity and frequency (from 1 Hz up to 100 Hz) are commonly used with efficacy in resolving musculoskeletal pain. EMFs therapy is a well tolerated, effective with no negative side effects, which can be integrated with rehabilitation for the treatment of chronic and acute pain in musculoskeletal diseases, but further studies are needed to examine the use of more standardized protocols.
Collapse
Affiliation(s)
- Teresa Paolucci
- Department of Medical Oral Sciences and Biotechnology (DiSmob), Physical Medicine and Rehabilitation Unit, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Letizia Pezzi
- Department of Medical Oral Sciences and Biotechnology (DiSmob), Physical Medicine and Rehabilitation Unit, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Antonello Marco Centra
- Department of Medical Oral Sciences and Biotechnology (DiSmob), Physical Medicine and Rehabilitation Unit, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Niki Giannandrea
- Department of Medical Oral Sciences and Biotechnology (DiSmob), Physical Medicine and Rehabilitation Unit, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Rosa Grazia Bellomo
- Department of Biomolecular Sciences, University of Study of Urbino Carlo Bo, Urbino, Italy
| | - Raoul Saggini
- Department of Medical Oral Sciences and Biotechnology (DiSmob), Physical Medicine and Rehabilitation Unit, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| |
Collapse
|
8
|
Pulsed Electromagnetic Field Stimulation of Bone Healing and Joint Preservation: Cellular Mechanisms of Skeletal Response. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:e1900155. [PMID: 33970582 PMCID: PMC7434032 DOI: 10.5435/jaaosglobal-d-19-00155] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The US FDA has approved pulsed electromagnetic fields (PEMFs) as a safe and effective treatment for nonunions of bone. Despite its clinical use, the mechanisms of action of electromagnetic stimulation of the skeleton have been elusive. Recently, cell membrane receptors have been identified as the site of action of PEMF and provide a mechanistic rationale for clinical use. This review highlights key processes in cell responses to PEMF as follows: (1) signal transduction through A2A and A3 adenosine cell membrane receptors and (2) dose-response effects on the synthesis of structural and signaling extracellular matrix (ECM) components. Through these actions, PEMF can increase the structural integrity of bone and cartilage ECM, enhancing repair, and alter the homeostatic balance of signaling cytokines, producing anti-inflammatory effects. PEMFs exert a proanabolic effect on the bone and cartilage matrix and a chondroprotective effect counteracting the catabolic effects of inflammation in the joint environment. Understanding of PEMF membrane targets, and of the specific intracellular pathways involved, culminating in the synthesis of ECM proteins and reduction in inflammatory cytokines, should enhance confidence in the clinical use of PEMF and the identification of clinical conditions likely to be affected by PEMF exposure.
Collapse
|
9
|
Konchugova TV, Kulchitskaya DB, Ivanov AV. [Efficiency of magnetic therapy techniques in the treatment and rehabilitation of patients with joint diseases from the standpoint of evidence-based medicine]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOĬ FIZICHESKOĬ KULTURY 2019; 96:63-68. [PMID: 31513170 DOI: 10.17116/kurort20199604163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article provides information on currently proven effective treatment methods for patients with joint diseases, by using magnetic fields with various physical characteristics. A wide range of biotropic parameters allows obtaining various primary physicochemical changes in biological tissues, which was a rationale for including magnetic therapy (MT) in the combination treatment of degenerative-dystrophic and inflammatory diseases. Analysis of scientific publications suggests that there are a large number of randomized, placebo-controlled studies providing evidence for reduced pain, improved joint functional activity and quality of life in patients with knee osteoarthritis under magnetic fields with varying inductions, frequencies, and exposures. There are few randomized clinical trials identifying the efficiency of MT for a number of other joint diseases and after arthroplasty. Despite the fact that there are differences in methodological approaches, it is possible to draw a general conclusion on the scientific validity of using MT in the complex treatment and rehabilitation programs for patients with joint diseases and on the prospects of further developments in this area.
Collapse
Affiliation(s)
- T V Konchugova
- National Medical Research Center for Rehabilitation and Balneology, Ministry of Health of Russia, Moscow, Russia; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
| | - D B Kulchitskaya
- National Medical Research Center for Rehabilitation and Balneology, Ministry of Health of Russia, Moscow, Russia
| | - A V Ivanov
- AO Elatma Instrumental-Making Plant, Elatma, Kasimov District, Ryazan Region, Russia
| |
Collapse
|
10
|
Gomes Gobbi R, Pastore E Silva AL, Kawamura Demange M, Pécora JR, Espregueira-Mendes J, Camanho GL. Clinical results of pulsed signal therapy on patellofemoral syndrome with patellar chondropathy. Bioelectromagnetics 2019; 40:83-90. [PMID: 30763468 DOI: 10.1002/bem.22172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/15/2019] [Indexed: 12/31/2022]
Abstract
This study was designed to evaluate the effect of pulsed signal therapy (PST) on patellofemoral pain syndrome associated with patellar chondropathy. A prospective randomized double-blind placebo controlled trial included 25 patients (41 knees) between 20 and 50 years with pain due to isolated patellofemoral syndrome with chondropathy. PST group received nine 60-min daily sessions of PST treatment. Control group received the same protocol of blinded placebo treatment. The main outcome was change from baseline Kujala score at 3 months. After 3 months, patients in the control group received effective treatment (placebo post-treatment). All patients were then followed, for up to 12 months. Seventeen knees (5 males and 12 females, mean age 36.7 ± 7.9) received placebo and 24 knees (8 males and 16 females, mean age 35.5 ± 8.9) received PST. By the third month, PST group exhibited a mean change from baseline of 9.63 ± 7.5 Kujala points, compared to 0.53 ± 1.8 in the placebo group (P < 0.001). A significant progressive improvement was seen in the PST group between the 3rd and 6th and between the 6th and 12th month (P < 0.016). Patients initially allocated in the control group also improved at 3 months (P < 0.001) and 6 months (P = 0.005) post-effective treatment. In conclusion, PST in patellofemoral pain syndrome with chondropathy was effective compared to placebo at 3 months, showing an important improvement of Kujala score. The improvement was progressive and maintained up to 12 months. PST is safe and should be considered as a non-invasive option for management of this condition. Bioelectromagnetics. 40:83-90, 2019. © 2019 Bioelectromagnetics Society.
Collapse
Affiliation(s)
- Riccardo Gomes Gobbi
- Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Marco Kawamura Demange
- Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - José Ricardo Pécora
- Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - João Espregueira-Mendes
- Clínica do Dragão, Espregueira-Mendes Sports Centre-FIFA Medical Centre of Excellence, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal.,Orthopaedics Department of Minho University, Minho, Portugal.,3B's Research Group-Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Barco/Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Gilberto Luis Camanho
- Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
11
|
Massari L, Benazzo F, Falez F, Perugia D, Pietrogrande L, Setti S, Osti R, Vaienti E, Ruosi C, Cadossi R. Biophysical stimulation of bone and cartilage: state of the art and future perspectives. INTERNATIONAL ORTHOPAEDICS 2019; 43:539-551. [PMID: 30645684 PMCID: PMC6399199 DOI: 10.1007/s00264-018-4274-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 12/03/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Biophysical stimulation is a non-invasive therapy used in orthopaedic practice to increase and enhance reparative and anabolic activities of tissue. METHODS A sistematic web-based search for papers was conducted using the following titles: (1) pulsed electromagnetic field (PEMF), capacitively coupled electrical field (CCEF), low intensity pulsed ultrasound system (LIPUS) and biophysical stimulation; (2) bone cells, bone tissue, fracture, non-union, prosthesis and vertebral fracture; and (3) chondrocyte, synoviocytes, joint chondroprotection, arthroscopy and knee arthroplasty. RESULTS Pre-clinical studies have shown that the site of interaction of biophysical stimuli is the cell membrane. Its effect on bone tissue is to increase proliferation, synthesis and release of growth factors. On articular cells, it creates a strong A2A and A3 adenosine-agonist effect inducing an anti-inflammatory and chondroprotective result. In treated animals, it has been shown that the mineralisation rate of newly formed bone is almost doubled, the progression of the osteoarthritic cartilage degeneration is inhibited and quality of cartilage is preserved. Biophysical stimulation has been used in the clinical setting to promote the healing of fractures and non-unions. It has been successfully used on joint pathologies for its beneficial effect on improving function in early OA and after knee surgery to limit the inflammation of periarticular tissues. DISCUSSION The pooled result of the studies in this review revealed the efficacy of biophysical stimulation for bone healing and joint chondroprotection based on proven methodological quality. CONCLUSION The orthopaedic community has played a central role in the development and understanding of the importance of the physical stimuli. Biophysical stimulation requires care and precision in use if it is to ensure the success expected of it by physicians and patients.
Collapse
Affiliation(s)
- Leo Massari
- University of Ferrara, Via Vigne 4, 44121, Ferrara, Italy.
| | - Franco Benazzo
- IRCCS Foundation "San Matteo" Hospital, University of Pavia, 27100, Pavia, Italy
| | | | | | | | | | | | | | - Carlo Ruosi
- Federico II University Naples, 80100, Naples, Italy
| | | |
Collapse
|
12
|
Management of Conditions Associated With Aging and Older Adults Using Therapeutic Electromagnetic Energy. TOPICS IN GERIATRIC REHABILITATION 2018. [DOI: 10.1097/tgr.0000000000000210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
13
|
Collarile M, Sambri A, Lullini G, Cadossi M, Zorzi C. Biophysical stimulation improves clinical results of matrix-assisted autologous chondrocyte implantation in the treatment of chondral lesions of the knee. Knee Surg Sports Traumatol Arthrosc 2018. [PMID: 28624853 DOI: 10.1007/s00167-017-4605-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE The purpose of the present study was to evaluate the effects of pulsed electromagnetic fields (PEMFs) on clinical outcome in patients who underwent arthroscopic matrix-assisted autologous chondrocyte implantation (MACI) for chondral lesions of the knee. METHODS Thirty patients affected by grade III and IV International Cartilage Repair Society chondral lesions of the knee underwent MACI. After surgery, patients were randomly assigned to either experimental group (PEMFs 4 h per day for 60 days) or control group . Clinical outcome was evaluated through International Knee Documentation Committee (IKDC) subjective knee evaluation form, Visual Analog Scale, Short Form-36 (SF-36) and EuroQoL before surgery and 1, 2, 6, and 60 months postoperative. RESULTS Mean size of chondral lesion was 2.4 ± 0.6 cm2 in the PEMFs group and 2.5 ± 0.5 cm2 in the control one. No differences were found between groups at baseline. IKDC score increased in both groups till 6 months, but afterward improvement was observed only in the experimental group with a significant difference between groups at 60 months (p = 0.001). A significant difference between groups was recorded at 60 months for SF-36 (p = 0.006) and EuroQol (p = 0.020). A significant pain reduction was observed in the experimental group at 1-, 2- and 60-month follow-up. CONCLUSION Biophysical stimulation with PEMFs improves clinical outcome after arthroscopic MACI for chondral lesions of the knee in the short- and long-term follow-up. Biophysical stimulation should be considered as an effective tool in order to ameliorate clinical results of regenerative medicine. The use of PEMFs represents an innovative therapeutic approach for the survival of cartilage-engineered constructs and consequently the success of orthopaedic surgery. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Marco Collarile
- Ospedale Sacro Cuore Don Calabria, Via Don Sempreboni 5, 37024, Negrar, VR, Italy
| | - Andrea Sambri
- Istituto Ortopedico Rizzoli, Via Cesare Pupilli 1, 40136, Bologna, Italy.
| | - Giada Lullini
- Istituto Ortopedico Rizzoli, Via Cesare Pupilli 1, 40136, Bologna, Italy
| | - Matteo Cadossi
- Istituto Ortopedico Rizzoli, Via Cesare Pupilli 1, 40136, Bologna, Italy
| | - Claudio Zorzi
- Ospedale Sacro Cuore Don Calabria, Via Don Sempreboni 5, 37024, Negrar, VR, Italy
| |
Collapse
|
14
|
Polastri M, Comellini V, Pacilli AMG, Nava S. Magnetic Stimulation Therapy in Patients with COPD: A Systematic Review. COPD 2018; 15:165-170. [PMID: 29558200 DOI: 10.1080/15412555.2018.1439910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Magnetotherapy (MT) is a therapeutic treatment based on the use of magnetic fields (MF) that can have an anti-inflammatory and analgesic effect. MT represents a possible treatment or an ancillary therapeutic intervention for a wide range of diseases and it is often used in the field of physiotherapeutic practices. A crucial point in the treatment of chronic obstructive pulmonary disease (COPD) patients, to counteract muscular depletion and respiratory symptoms, is represented by physiotherapy. Nevertheless, the knowledge about the application of MF as a therapeutic option in COPD patients is very limited. The purpose of the present study was to define what is currently known about the use of MF in patients with COPD. A systematic review of the literature was conducted during the month of October 2017, searching three main databases. Only those citations providing detailed informations about the use of MF to treat COPD symptoms either during an acute or a chronic phase of the disease, were selected. Following the selection process three articles were included in the final analysis. The present review focused on a total of thirty-six patients with COPD, and on the effects of the application of MF. In the majority of cases, the treatment sessions with MF were carried-out in an outpatient setting, and they differed with regard to the duration; frequency of application; dosage; intensity of the applied MF. Basing on the available informations, it seems that MF is a feasible, well tolerated, safe therapeutic option, for the treatment of motor-related COPD symptoms.
Collapse
Affiliation(s)
- Massimiliano Polastri
- a Medical Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation , University Hospital St. Orsola-Malpighi , Bologna , Italy
| | - Vittoria Comellini
- b Respiratory and Critical Care Unit , University Hospital St. Orsola-Malpighi , Bologna , Italy
| | - Angela Maria Grazia Pacilli
- c Department of Specialistic, Diagnostic and Experimental Medicine (DIMES) , Alma Mater Studiorum University of Bologna , Bologna , Italy
| | - Stefano Nava
- b Respiratory and Critical Care Unit , University Hospital St. Orsola-Malpighi , Bologna , Italy.,c Department of Specialistic, Diagnostic and Experimental Medicine (DIMES) , Alma Mater Studiorum University of Bologna , Bologna , Italy
| |
Collapse
|