Sustained acoustic medicine for the treatment of musculoskeletal injuries: a systematic review and meta-analysis

Bioadhesive Technology Platforms

Bioadhesives have emerged as transformative and versatile tools in healthcare, offering the ability to attach tissues with ease and minimal damage. These materials present numerous opportunities for tissue repair and biomedical device integration, creating a broad landscape of applications that have captivated clinical and scientific interest alike. However, fully unlocking their potential requires multifaceted design strategies involving optimal adhesion, suitable biological interactions, and efficient signal communication. In this Review, we delve into these pivotal aspects of bioadhesive design, highlight the latest advances in their biomedical applications, and identify potential opportunities that lie ahead for bioadhesives as multifunctional technology platforms.

Clinical Diathermy Performance Evaluation of Multi-hour Sustained Acoustic Medicine Treatment with 2.5% Diclofenac Ultrasound Coupling Patch

Background

Low-intensity Continuous Ultrasound (LICUS) therapy heals soft tissue injuries. It alleviates acute and chronic musculoskeletal pain by activating multiple healing processes through its diathermic and mechanotransducive properties. Diclofenac has been FDA-approved as a Non-Steroidal Anti-Inflammatory Drug (NSAID). It is an analgesic and anti-inflammatory drug available in oral and topical forms. Adding 2.5% diclofenac sodium to ultrasound coupling gel can be used to deliver LICUS in addition to the analgesic effects of diclofenac sodium without altering the diathermic and acoustic effects of the ultrasound penetration with no undesired adverse effects.

Objective

To determine the effects of adding 2.5% diclofenac sodium to standard aqueous ultrasound gel on the ultrasound coupling and diathermic properties of a long duration Sustained Acoustic Medicine (SAM) treatment.

Methods

In a two-phase study, first, the acoustic and diathermic changes were determined in bovine tissue during 4-hour-long SAM stimulation at 1 cm, 2 cm, and 5 cm with aqueous and 2.5% diclofenac ultrasound coupling patch. Then, in the second phase, the heating profiles were recorded with and without 2.5% diclofenac gel in 54 healthy adult subjects at the forearm and calf during the SAM treatment.

Result

The addition of 2.5% diclofenac sodium significantly increased coupling gel density, acoustic impedance, and signal propagation (p<0.0001) with little or no effect on the diathermic profiles at 1 cm, 2 cm, and 5 cm depth. The coupling gel with 2.5% diclofenac sodium sustained the therapeutic ultrasound intensity longer than the aqueous coupling gel (5.5 cm relative to 4.5, p<0.0009). No significant diathermic difference was recorded on the calf and forearm skin with a 2.5% diclofenac ultrasound gel coupling patch.

Conclusion

Adding 2.5% diclofenac sodium to ultrasound gel increases acoustic impedance, improves ultrasound signal coupling into deep tissue, and provides longer sustained deep tissue heating without negatively impacting the diathermic profile during SAM treatment.

Long Duration Sonophoresis of Diclofenac to Augment Rehabilitation of Common Musculoskeletal Injuries

Background

The use of long duration sonophoresis (LDS) for musculoskeletal injuries is a new and emerging treatment option for patients undergoing rehabilitation. The treatment is non-invasive, provides multi-hour mechanical stimulus expediating tissue regeneration and deep tissue heat along with local application of therapeutic compound for improved pain relief. The objective of this prospective case study was to evaluate real-world application of diclofenac LDS as an add-on intervention for patients non-responsive to physical therapy alone.

Methods

Patient who failed to respond to at least 4 weeks of physical therapy were treated with the addition of 2.5% diclofenac LDS daily for 4 weeks. The numerical rating scale, global health improvement score, functional improvement, and treatment satisfaction index were measured to assess pain reduction and quality of life improvement from treatment. Patient outcome data was organized by injury type and patient age groups, and statistically analyzed with ANOVA to assess treatment differences within and between groups. The study was registered on clinicaltrails.gov NCT05254470.

Result

The study included (n=135) musculoskeletal injury LDS treatments with no adverse events. Patients reported a mean pain reduction from baseline of 4.44 points (p<0.0001) and a 4.85point health improvement score after 4-week of daily sonophoresis treatment. There were no age-related differences in pain reduction, and 97.8% of patients in the study reported functional improvement with the addition of LDS treatment. Significant pain relief was observed in injuries related to tendinopathy, sprain, strain, contusion, bone fracture, and post-surgical recovery.

Conclusion

The use of LDS significantly reduced pain and improved musculoskeletal function and quality of life for patients. Clinical findings suggest that LDS with 2.5% diclofenac is a viable therapeutic option for practitioners and should be further investigated.

The Thermal Influence of an Electromagnetic Field with a Radio Frequency Depending on the Type of Electrode Used

Diathermy is a method used in physiotherapy based on obtaining an increase in temperature by supplying energy from the electromagnetic field to the tissues. The aim of this retrospective work, based on the data included in a medical documentation, was to assess the dynamics of temperature changes on the body surface after the application of a high-frequency electromagnetic field depending on the type of electrode used. In order to generate a radio frequency electromagnetic field, an INDIBA ACTIV^® CT9 was used. In order to measure the temperature, an HT-17 thermovision camera was used, enabling measurements within the range of -20 to 300 °C, with an accuracy of ±2% or 2 °C. The participants consisted of 30 healthy subjects (15 women and 15 men) who were physiotherapy students in the Faculty of Public Health in the Silesian Medical University in Katowice, Poland; they were divided into two comparative groups (A and B). It was found that the differences between the groups were not significant in the measurements carried out before using the electrode (p = 0.84; Mann-Whitney U test). On the other hand, at 0, 5 and 15 min, statistically significant differences were noted in the tissue temperature between the groups, depending on the electrode used (p = 0.00; Mann-Whitney U test). Based on the obtained results, it can be concluded that with the extension of the observation time, the tissue temperature increased (for Group A, Me 30.40 °C vs. 34.90 °C; for Group B, Me 30.70 °C vs. 35.20 °C). Our study confirmed that the use of both a capacitive and resistive electrode during treatment with the use of a high-frequency electromagnetic field statistically significantly increased the surface temperature of the area to which the therapy was applied. The results of the study can be used in clinical practice by physiotherapists to optimize the conditions of therapy.