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Paolucci T, Porto D, Pellegrino R, Sina O, Fero A, D'Astolfo S, Franceschelli S, Patruno A, Fusco A, Pesce M. Combined Rehabilitation Protocol in the Treatment of Osteoarthritis of the Knee: Comparative Study of Extremely Low-Frequency Magnetic Fields and Soft Elastic Knee Brace Effect. Healthcare (Basel) 2023; 11:healthcare11091221. [PMID: 37174763 PMCID: PMC10178194 DOI: 10.3390/healthcare11091221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/29/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
The investigation of this observational case-control study aimed at determining the effectiveness of a combined treatment of extremely low-frequency electromagnetic fields (ELF) with a soft elastic knee brace versus ELF alone in knee osteoarthritis (KOA) with respect to a reduction in pain and functional recovery. We hypothesized that the combined use of ELF and a soft elastic knee brace may provide better results. Thirty-five patients (N = 35, divided into Group 1 = ELF and Group 2 = ELF with the soft elastic knee brace) were analyzed. The rehabilitative protocol consisted of 10 sessions of antiphlogistic and antiedema programs (first cycle) for 2 weeks, followed by twelve sessions of bone repair and connective tissue repair programs (second cycle) in patients with knee osteoarthritis (KOA) for 4 weeks. Patient evaluations were conducted at baseline (T0) and after 2 (T1) and 4 (T2) weeks of treatment. A follow-up evaluation was conducted 6 weeks after treatment (T3). The LIMFA© Therapy System was used to create multifrequency magnetoelectric fields with an intensity of 100 µT and a low-frequency field. The Incrediwear Cred 40 knee sleeve (Incred) was used for alleviating knee pain. The Visual Analogue Scale (VAS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Lysholm score (Ls) were used as outcome measures. The results showed that pain at rest (Vr), pain in motion (Vm), KOOS, and Ls were significantly affected by ELF over time. In conclusion, Group 2 had a better response in terms of pain resolution at rest (p < 0.05) and a concurrent better response at T3 in terms of functional recovery (p < 0.05).
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Affiliation(s)
- Teresa Paolucci
- Department of Oral, Medical and Biotechnological Sciences, Physical Medicine and Rehabilitation, University of G. D'Annunzio Chieti-Pescara, 66100 Chieti, Italy
| | - Daniele Porto
- Unit of Physical Medicine and Rehabilitation, Don Orione Institute, 65128 Pescara, Italy
| | - Raffaello Pellegrino
- Department of Scientific Research, Campus Ludes, Semmelweis University, 6912 Lugano, Switzerland
| | - Ornela Sina
- Unit of Physical Medicine and Rehabilitation, Don Orione Institute, 65128 Pescara, Italy
| | - Andi Fero
- Unit of Physical Medicine and Rehabilitation, Don Orione Institute, 65128 Pescara, Italy
| | - Sara D'Astolfo
- Unit of Physical Medicine and Rehabilitation, Don Orione Institute, 65128 Pescara, Italy
| | - Sara Franceschelli
- Department of Medicine and Aging Science, University of G. D'Annunzio Chieti-Pescara, 66100 Chieti, Italy
| | - Antonia Patruno
- Department of Medicine and Aging Science, University of G. D'Annunzio Chieti-Pescara, 66100 Chieti, Italy
| | - Augusto Fusco
- UOC Neuroriabilitazione ad Alta Intensità, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Mirko Pesce
- Department of Medicine and Aging Science, University of G. D'Annunzio Chieti-Pescara, 66100 Chieti, Italy
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Tong J, Chen Z, Sun G, Zhou J, Zeng Y, Zhong P, Deng C, Chen X, Liu L, Wang S, Chen J, Liao Y. The Efficacy of Pulsed Electromagnetic Fields on Pain, Stiffness, and Physical Function in Osteoarthritis: A Systematic Review and Meta-Analysis. Pain Res Manag 2022; 2022:9939891. [PMID: 35586276 PMCID: PMC9110240 DOI: 10.1155/2022/9939891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/02/2022] [Indexed: 11/17/2022]
Abstract
Background Although there are many pharmacological interventions for adults with osteoarthritis (OA) who do not meet the indications for surgery, side effects and adverse effects cannot be ignored. Physical interventions are known for their effectiveness and safety, and pulsed electromagnetic fields (PEMFs) have already been applied to skeletal diseases such as osteoporosis. Objective In this systematic review and meta-analysis, we aimed to assess the efficacy of PEMF on the major symptoms of patients with OA compared with efficacy of other interventions. Methods Randomized controlled trials (RCTs) investigating OA patients treated with PEMF and with pain, stiffness, and physical function impairment since 2009 were included. The Visual Analog Scale (VAS) and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) scores were used for assessment. All extracted data were analyzed using RevMan V.5.3. Results Eleven RCTs consisting of 614 patients were enrolled in this meta-analysis, of which 10 trials comprised knee OA and one comprised hand OA. Compared with the control groups, the PEMF treatment yielded a more favorable output. PEMF alleviated pain (standardized mean differences [SMD] = 0.71, 95% confidence interval [CI]: 0.08-1.34, p = 0.03), improved stiffness (SMD = 1.34, 95% CI: 0.45-2.23,p=0.003), and restored physical function (SMD = 1.52, 95% CI: 0.49-2.55,p=0.004). Conclusions PEMF therapy ameliorates OA symptoms such as pain, stiffness, and physical function in patients compared to other conservative treatments. There is an urgent need to search for different types of OA in multiple locations.
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Affiliation(s)
- Jie Tong
- Rehabilitation Medicine Center, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
- Department of Rehabilitation, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
- Rehabilitation Laboratory, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
| | - Zhengyu Chen
- Department of Spine, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
| | - Guanghua Sun
- Rehabilitation Medicine Center, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
- Department of Rehabilitation, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
- Rehabilitation Laboratory, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
| | - Jun Zhou
- Rehabilitation Medicine Center, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
- Department of Rehabilitation, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
- Rehabilitation Laboratory, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
| | - Ye Zeng
- Rehabilitation Medicine Center, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
- Department of Rehabilitation, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
- Rehabilitation Laboratory, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
| | - Peirui Zhong
- Rehabilitation Medicine Center, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
- Department of Rehabilitation, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
- Rehabilitation Laboratory, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
| | - Chengyuan Deng
- Department of Anatomy, Hunan Traditional Chinese Medical College, Zhuzhou, Hunan 421001, China
| | - Xiaocui Chen
- Department of Rehabilitation, Affiliated Hospital of Jiangnan University, Wuxi, Jiangsu 214000, China
| | - Liu Liu
- Rehabilitation Medicine Center, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
- Department of Rehabilitation, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
- Rehabilitation Laboratory, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
| | - Shiyong Wang
- Rehabilitation Medicine Center, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
- Department of Rehabilitation, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
- Rehabilitation Laboratory, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
| | - Jiaqian Chen
- Rehabilitation Medicine Center, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
- Department of Rehabilitation, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
- Rehabilitation Laboratory, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
| | - Ying Liao
- Rehabilitation Medicine Center, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
- Department of Rehabilitation, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
- Rehabilitation Laboratory, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China
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Effectiveness of pulsed electromagnetic field therapy in the management of complex regional pain syndrome type 1: A randomized-controlled trial. Turk J Phys Med Rehabil 2022; 68:107-116. [PMID: 35949961 PMCID: PMC9305649 DOI: 10.5606/tftrd.2022.9074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 12/08/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives: This study aims to investigate whether pulsed electromagnetic field (PEMF) therapy in addition to a conventional rehabilitation program is effective on pain and functioning in patients with type 1 complex regional pain syndrome (CRPS-1) of the hand.
Patients and methods: Between March 2013 and January 2015, a total of 32 patients (16 males, 16 females; mean age: 50.1±13.1 years; range, 25 to 75 years) were included. The patients were randomly allocated into two groups. The control group (n=16) received a conventional rehabilitation program consisting of physical modalities, exercises, and occupational therapy, whereas the PEMF group (n=16) received additional PEMF (8 Hz, 3.2 mT) to the affected hand. The primary outcome measure was pain intensity using the Numeric Rating Scale (NRS). Secondary outcome measures were grip and pinch strength, hand edema, hand dexterity, and hand activities. All patients received 20 therapy sessions (five sessions/week, four weeks in total) and were evaluated before and after the therapy and at the first-month follow-up.
Results: Both groups showed significant improvements in primary and secondary outcomes (p<0.05) after the therapy and at follow-up. When the groups were compared in terms of improvements in assessment parameters, no statistically significant difference was found between the two groups in any of the outcomes (p>0.05).
Conclusion: The PEMF in addition to conventional rehabilitation program did not provide additional benefit for pain and hand functions in CRPS-1. Future studies using different application parameters such as frequency, intensity, duration, and route may provide a better understanding of the role of PEMF in CRPS-1 treatment.
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Viganò M, Perucca Orfei C, Ragni E, Colombini A, de Girolamo L. Pain and Functional Scores in Patients Affected by Knee OA after Treatment with Pulsed Electromagnetic and Magnetic Fields: A Meta-Analysis. Cartilage 2021; 13:1749S-1760S. [PMID: 32508140 PMCID: PMC8808910 DOI: 10.1177/1947603520931168] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The purpose of this systematic review and meta-analysis was to evaluate the effect of electromagnetic field treatment on the symptoms of knee osteoarthritis (OA). In addition, the influence of the type of control group and other covariates have been investigated to identify the sources of heterogeneity in the results of the available clinical trials. METHODS Randomized controlled trials reporting pulsed electromagnetic field-based therapies for the treatment of knee OA have been included. Main outcomes were self-reported pain and activity scores collected by Visual Analogue Scale (VAS) and/or Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) at short term after treatment. RESULTS Thirteen studies comprising 914 unique patients were included in the analysis. Overall reduction in pain score was observed after treatment (standardized mean difference -0.4059, P = 0.0091), while improvement in the activity score was not significant (standardized mean difference -0.4452, P = 0.0859). Type of control (i.e., placebo or alternative therapies) and time of follow-up resulted as the two major elements influencing the outcomes. Indeed, the restriction of the analysis to placebo-controlled trials demonstrated higher standardized mean differences between treatment and control groups, with lower P value for pain, while statistical significance became evident also for the activity score. On the contrary, no differences were observed pooling only studies comparing pulsed electromagnetic or magnetic fields to alternative treatments. In addition, longer follow-up correlated with lower differences between treated and control patients. CONCLUSIONS Pulsed electromagnetic field therapy effectively relieves knee OA symptoms at short term, but it is not superior to other conservative therapies such as physiotherapy.
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Affiliation(s)
- Marco Viganò
- IRCCS Istituto Ortopedico Galeazzi,
Milano, Italy
| | - Carlotta Perucca Orfei
- IRCCS Istituto Ortopedico Galeazzi,
Milano, Italy,Carlotta Perucca Orfei, Laboratorio di
Biotecnologie Applicate all’Ortopedia, IRCCS Istituto Ortopedico Galeazzi, Via
R. Galeazzi 4, Milan 20161, Italy.
| | - Enrico Ragni
- IRCCS Istituto Ortopedico Galeazzi,
Milano, Italy
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Song Y, Hao D, Jiang H, Huang M, Du Q, Lin Y, Liu F, Chen B. Nrf2 Regulates CHI3L1 to Suppress Inflammation and Improve Post-Traumatic Osteoarthritis. J Inflamm Res 2021; 14:4079-4088. [PMID: 34466014 PMCID: PMC8403022 DOI: 10.2147/jir.s310831] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/18/2021] [Indexed: 01/16/2023] Open
Abstract
Introduction Post-traumatic osteoarthritis (PTOA) is an inflammatory condition that occurs following mechanical joint trauma and that results in joint degeneration. This study sought to evaluate the regulatory function of nuclear factor erythroid 2-related factor 2 (Nrf2) in a murine model of anterior cruciate ligament transection (ACLT)-induced PTOA and in an in vitro model of synoviocyte inflammation induced by LPS treatment with the goal of exploring the role of chitinase 3-like-1 (CHI3L1) in this pathogenic context. Methods PTOA model mice were intra-articularly injected with Nrf2 overexpression lentiviral vector, and safranin O-fast green staining as well as the Osteoarthritis Research Society International (OARSI) Scoring System were used to evaluate the severity of cartilage damage. Protein expression in the synovial tissue was evaluated by Western blotting, immunohistochemical staining, and ELISA. Additionally, murine synoviocytes were infected with Nrf2 overexpression lentivirus and stimulated with LPS. The levels of inflammatory cytokines were detected by ELISA. ROS levels were measured using dihydroethidium (DHE) dye. Results We determined that the overexpression of Nrf2 was sufficient to reduce cartilage degradation in the context of PTOA in vivo, and we observed a significant decrease in the expression of matrix metalloproteinase 13 (MMP13) in the articular cartilage of samples from mice overexpressing Nrf2 relative to control mice. Synovial CHI3L1 expression and serum TNF-α, IL-1β, and IL-6 levels were reduced in animals overexpressing this transcription factor relative to PTOA model controls. Consistent with these findings, murine synoviocytes treated with LPS exhibited dose-dependent increases in ROS, TNF-α, IL-1β, IL-6, Nrf2, and CHI3L1 levels, whereas Nrf2 overexpression was sufficient to suppress these increases. Conclusion Our data indicated that Nrf2 negatively regulates CHI3L1, suggesting that this signaling axis may regulate PTOA progression and may thus be a viable therapeutic target in individuals affected by this condition.
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Affiliation(s)
- Yang Song
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China.,Division of Traumatology and Joint, Department of Orthopaedics, Shunde Hospital, Southern Medical University, Foshan, 528308, People's Republic of China
| | - Dake Hao
- Department of Surgery, School of Medicine, University of California Davis, Sacramento, CA, 95817, USA
| | - Huan Jiang
- Department of Anesthesiology, Shunde Hospital, Southern Medical University, Foshan, 528308, People's Republic of China
| | - Mingguang Huang
- Division of Traumatology and Joint, Department of Orthopaedics, Shunde Hospital, Southern Medical University, Foshan, 528308, People's Republic of China
| | - Qingjun Du
- Division of Traumatology and Joint, Department of Orthopaedics, Shunde Hospital, Southern Medical University, Foshan, 528308, People's Republic of China
| | - Yi Lin
- Division of Traumatology and Joint, Department of Orthopaedics, Shunde Hospital, Southern Medical University, Foshan, 528308, People's Republic of China
| | - Fei Liu
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Bin Chen
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, People's Republic of China
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Yang X, He H, Ye W, Perry TA, He C. Effects of Pulsed Electromagnetic Field Therapy on Pain, Stiffness, Physical Function, and Quality of Life in Patients With Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials. Phys Ther 2020; 100:1118-1131. [PMID: 32251502 DOI: 10.1093/ptj/pzaa054] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 04/09/2019] [Accepted: 12/20/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Pulsed electromagnetic field (PEMF) therapy is a potentially useful treatment for osteoarthritis (OA), but its effectiveness is still controversial. This study aimed to examine the effects of PEMF therapy and PEMF parameters on symptoms and quality of life (QOL) in patients with OA. METHODS Cochrane Central Register of Controlled Trials, PubMed, CINAHL, EMBASE, PEDro, clinical trial registers, and reference lists were searched until April 2019. This study examined randomized, placebo-controlled trials, patients with OA, symptom and/or QOL related outcomes, and articles published in English. Two authors extracted data and completed quality assessment. RESULTS Sixteen studies were included in our systematic review, while 15 studies with complete data were included in the meta-analysis. Our primary outcome was the standardized mean difference, which was equal to the treatment effect in the PEMF group minus the treatment effect in the placebo group divided by the pooled standard deviation. For pain, the standardized mean difference was 1.06 (95% CI = 0.61 to 1.51), for stiffness 0.37 (95% CI = 0.07 to 0.67), for function 0.46 (95% CI = 0.14 to 0.78), and for QOL 1.49 (95% CI = -0.06 to 3.04). PEMF parameters did not influence symptoms. CONCLUSIONS Compared with placebo, there was a beneficial effect of PEMF therapy on pain, stiffness, and physical function in patients with OA. Duration of treatment may not be a critical factor in pain management. Further studies are required to confirm the effects of PEMF therapy on QOL. IMPACT Our study suggests that PEMF therapy has clinically significant effects on pain in patients with OA. The current evidence was limited to the short-term effects of PEMF therapy.
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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.
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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
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Ehnert S, Schröter S, Aspera-Werz RH, Eisler W, Falldorf K, Ronniger M, Nussler AK. Translational Insights into Extremely Low Frequency Pulsed Electromagnetic Fields (ELF-PEMFs) for Bone Regeneration after Trauma and Orthopedic Surgery. J Clin Med 2019; 8:jcm8122028. [PMID: 31756999 PMCID: PMC6947624 DOI: 10.3390/jcm8122028] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/15/2019] [Accepted: 11/18/2019] [Indexed: 02/07/2023] Open
Abstract
The finding that alterations in electrical potential play an important role in the mechanical stimulation of the bone provoked hype that noninvasive extremely low frequency pulsed electromagnetic fields (ELF-PEMF) can be used to support healing of bone and osteochondral defects. This resulted in the development of many ELF-PEMF devices for clinical use. Due to the resulting diversity of the ELF-PEMF characteristics regarding treatment regimen, and reported results, exposure to ELF-PEMFs is generally not among the guidelines to treat bone and osteochondral defects. Notwithstanding, here we show that there is strong evidence for ELF-PEMF treatment. We give a short, confined overview of in vitro studies investigating effects of ELF-PEMF treatment on bone cells, highlighting likely mechanisms. Subsequently, we summarize prospective and blinded studies, investigating the effect of ELF-PEMF treatment on acute bone fractures and bone fracture non-unions, osteotomies, spinal fusion, osteoporosis, and osteoarthritis. Although these studies favor the use of ELF-PEMF treatment, they likewise demonstrate the need for more defined and better controlled/monitored treatment modalities. However, to establish indication-oriented treatment regimen, profound knowledge of the underlying mechanisms in the sense of cellular pathways/events triggered is required, highlighting the need for more systematic studies to unravel optimal treatment conditions.
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Affiliation(s)
- Sabrina Ehnert
- Siegfried Weller Institute for Trauma Research, Depterment of Trauma and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, D-72076 Tübingen, Germany; (S.S.); (R.H.A.-W.); (W.E.); (A.K.N.)
- Correspondence: or ; Tel.: +49-7071-606-1067
| | - Steffen Schröter
- Siegfried Weller Institute for Trauma Research, Depterment of Trauma and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, D-72076 Tübingen, Germany; (S.S.); (R.H.A.-W.); (W.E.); (A.K.N.)
| | - Romina H. Aspera-Werz
- Siegfried Weller Institute for Trauma Research, Depterment of Trauma and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, D-72076 Tübingen, Germany; (S.S.); (R.H.A.-W.); (W.E.); (A.K.N.)
| | - Wiebke Eisler
- Siegfried Weller Institute for Trauma Research, Depterment of Trauma and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, D-72076 Tübingen, Germany; (S.S.); (R.H.A.-W.); (W.E.); (A.K.N.)
| | - Karsten Falldorf
- Sachtleben GmbH, Hamburg, Haus Spectrum am UKE, Martinistraße 64, D-20251 Hamburg, Germany; (K.F.); (M.R.)
| | - Michael Ronniger
- Sachtleben GmbH, Hamburg, Haus Spectrum am UKE, Martinistraße 64, D-20251 Hamburg, Germany; (K.F.); (M.R.)
| | - Andreas K. Nussler
- Siegfried Weller Institute for Trauma Research, Depterment of Trauma and Reconstructive Surgery, BG Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, D-72076 Tübingen, Germany; (S.S.); (R.H.A.-W.); (W.E.); (A.K.N.)
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Hakimi F, Asheghan M, Hashemi SE. Isometric exercise, acupuncture, and magnet therapy for knee osteoarthritis: randomized clinical trial. REHABILITACJA MEDYCZNA 2019. [DOI: 10.5604/01.3001.0013.3766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Knee osteoarthritis is a common disease, particularly in the elderly population. Degenerative disorders of the cartilage cause pain and stiffness in the knee joint. As a result, patients frequently experience limitation in their daily activities.
Purpose: To compare the effects of exercise, acupuncture, and magnet therapy on symptoms and physical function among middle-aged and elderly people with knee osteoarthritis.
Materials and methods: We carried out a parallel three-arm randomized clinical trial in an outpatient clinic of the Department of Physical Medicine and Rehabilitation at a University Hospital. In total, 60 female patients of age ≥ 40 years with chronic knee osteoarthritis were randomly allocated to one of three groups of isometric exercise, acupuncture, and magnet therapy. The primary outcome measure was subjective pain rated according to the Visual Analog Scale. We also used the Western Ontario McMaster Universities Osteoarthritis Index for assessing and monitoring the symptoms of knee osteoarthritis in order to evaluate the efficacy of the interventions. An isometric exercise program was prescribed, consisting of three sessions per week for six weeks. Participants in the acupuncture group received three treatment sessions per week for six weeks, each lasting for 30 minutes. For pulsed electro-magnetic field therapy, a total of three 30-minute sessions per week for a period of 6 weeks were administered to each patient.
Results: There were no statistically significant differences between the study groups in terms of the outcome measures (all p values > 0.05). However, within-group analyses showed that there were significant differences regarding the clinical outcomes in each group (all p values < 0.05).
Conclusion: All three therapeutic modalities are effective and could be used as the first line of treatment for knee osteoarthritis. Moreover, it should be noted that the favorable outcomes remained at least two months after treatment concluded.
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Affiliation(s)
| | - Mahsa Asheghan
- Exercise Physiology Research Center, Baqiyatallah University of Medical Sciences, Iran
| | - Seyed Ebrahim Hashemi
- Exercise Physiology Research Center, Baqiyatallah University of Medical Sciences, Iran
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Wu Z, Ding X, Lei G, Zeng C, Wei J, Li J, Li H, Yang T, Cui Y, Xiong Y, Wang Y, Xie D. Efficacy and safety of the pulsed electromagnetic field in osteoarthritis: a meta-analysis. BMJ Open 2018; 8:e022879. [PMID: 30552258 PMCID: PMC6303578 DOI: 10.1136/bmjopen-2018-022879] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 07/21/2018] [Accepted: 10/19/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To investigate the efficacy and safety of the pulsed electromagnetic field (PEMF) therapy in treating osteoarthritis (OA). DESIGN Meta-analysis. DATA SOURCES PubMed, Embase, the Cochrane Library and Web of Science were searched through 13 October 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials compared the efficacy of PEMF therapy with sham control in patients with OA. DATA EXTRACTION AND SYNTHESIS Pain, function, adverse effects and characteristics of participants were extracted. RevMan V.5.2 was used to perform statistical analyses. RESULTS Twelve trials were included, among which ten trials involved knee OA, two involved cervical OA and one involved hand OA. The PEMF group showed more significant pain alleviation than the sham group in knee OA (standardised mean differences (SMD)=-0.54, 95% CI -1.04 to -0.04, p=0.03) and hand OA (SMD=-2.85, 95% CI -3.65 to -2.04, p<0.00001), but not in cervical OA. Similarly, comparing with the sham-control treatment, significant function improvement was observed in the PEMF group in both knee and hand OA patients (SMD=-0.34, 95% CI -0.53 to -0.14, p=0.0006, and SMD=-1.49, 95% CI -2.12 to -0.86, p<0.00001, respectively), but not in patients with cervical OA. Sensitivity analyses suggested that the exposure duration <=30 min per session exhibited better effects compared with the exposure duration >30 min per session. Three trials reported adverse events, and the combined results showed that there was no significant difference between PEMF and the sham group. CONCLUSIONS PEMF could alleviate pain and improve physical function for patients with knee and hand OA, but not for patients with cervical OA. Meanwhile, a short PEMF treatment duration (within 30 min) may achieve more favourable efficacy. However, given the limited number of study available in hand and cervical OA, the implication of this conclusion should be cautious for hand and cervical OA.
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Affiliation(s)
- Ziying Wu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Xiang Ding
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Jie Wei
- Department of Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Jiatian Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Hui Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Tuo Yang
- Department of Health Management Center, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Yang Cui
- International Medical Department, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Yilin Xiong
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Yilun Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Dongxing Xie
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
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11
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Wang P, Song J, Qian D. CTX-II and YKL-40 in early diagnosis and treatment evaluation of osteoarthritis. Exp Ther Med 2018; 17:423-431. [PMID: 30651816 PMCID: PMC6307395 DOI: 10.3892/etm.2018.6960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/30/2018] [Indexed: 12/26/2022] Open
Abstract
This study investigated the value of C-terminal telopeptides of collagen type II (CTX-II) and YKL-40 in early diagnosis and treatment evaluation of osteoarthritis (OA). A total of 90 patients with OA diagnosed and treated in The First Affiliated Hospital, Guangzhou Medical University from March 2015 to January 2018 were selected as the study group. At the same time, 50 healthy elderly were included as the control group. The study group was divided into three subgroups including group A (29 cases, 500 mg glucosamine sulfate), group B (29 cases, 50 mg diacerein) and group C (32 cases, 500 mg glucosamine sulfate and 50 mg diacerein). Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to assess the severity and treatment of arthritis. Enzyme-linked immunosorbent assay was used to measure the concentration of CTX-II and YKL-40 in serum. WOMAC scores in the study A, B and C groups were significantly higher than those in the control group (P<0.001). Serum CTX-II and YKL-40 concentrations were higher in the study group than in the control group (P<0.001). Sensitivity of serum CTX-II combined with YKL-40 in the diagnosis of OA was 90% and the specificity was 78%. CTX-II and YKL-40 levels in different Kellgren Lawrence (K-L) grades were significantly different (P<0.001), and increased with the increase of K-L grade. Concentrations of serum CTX-II and YKL-40 before treatment in the study group was positively correlated with WOMAC score (P<0.001). At 3, 6 and 9 weeks after the beginning of treatment, serum concentrations of CTX-II and YKL-40 decreased significantly (P<0.001). At 3 weeks of treatment, CTX-II was positively correlated with YKL-40 concentration and WOMAC score (r=0.406, P<0.001; r=0.430, P<0.001); CTX-II was positively correlated with YKL-40 concentration and WOMAC score at 6 weeks of treatment (r=0.350, P<0.001; r=0.358, P<0.001); CTX-II was positively correlated with YKL-40 concentration and WOMAC score at 9 weeks after treatment (r=0.370, P<0.001; r=0.394, P<0.001). Combined detection of serum CTX-II and YKL-40 can improve the sensitivity of early OA diagnosis, and it has an important diagnostic value for early OA patients. Therefore, it can be used as a biological indicator for early OA diagnosis, severity assessment, and evaluation of treatment effects.
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Affiliation(s)
- Pengkun Wang
- Department of Clinical Laboratory, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China
| | - Jinlong Song
- Department of Clinical Laboratory, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China
| | - Dongyang Qian
- Department of Orthopaedics, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510120, P.R. China
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Abstract
Osteoarthritis (OA), the most common form of arthritis, causes pain and disability, as well as emotional distress. While total joint replacement is one of the most effective treatments available for improving the quality of life in people with severe OA, it is not suitable for all patients and all joints. Current pharmacological analgesics have limited efficacy, and their use is often restricted by adverse events. Medications that might reduce pain by slowing or preventing structural disease remain elusive. Our increasing understanding of the complex mechanisms that underlie OA pain offers a wide range of potential new treatment targets. New drugs for OA pain might come from repurposing those developed for other conditions, as well as novel compounds targeting pain mechanisms specific to the joint. Here we discuss the mechanisms of OA pain and its therapeutic implications. We explore evolving treatment modalities, including combination treatment. We review recent research and patents pointing to future OA therapies. We discuss the potential for biomarkers to facilitate drug development and targeting.
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Affiliation(s)
- David A Walsh
- 1 Arthritis Research UK Pain Centre, University of Nottingham, UK.,2 Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, UK.,3 NIHR Nottingham BRC, UK.,4 Sherwood Forest Hospitals NHS Foundation Trust, UK.,5 Nottingham University Hospitals NHS Trust, UK
| | - Joanne Stocks
- 1 Arthritis Research UK Pain Centre, University of Nottingham, UK.,2 Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, UK.,3 NIHR Nottingham BRC, UK
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