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J.-L. Larochelle1, J. Omer Dyer1, R. Breault1, A. Pelletier1, C. Fortin2
1University of Montreal, School of Rehabilitation, Montreal, Canada, 2University of Ottawa, School of Psychology, Ottawa, Canada
Background: Ultrasound therapy is the most popular electrophysical agent used by physiotherapists to directly modulate biological processes involved in musculoskeletal disorders (MSDs). Although there is undisputed fundamental laboratory evidence supporting its role for promoting tissue healing response through mechanotransduction, clinical trials demonstrate that it fails to meet clinical expectations for treating MSDs or if it does, it can hardly be implemented due to intensive treatment regimens. Therefore, many suggest discontinuing its use in physiotherapy. We rather suggest that clinical implementation and delivery processes should be further addressed, especially through innovative technologies. Indeed, for the past decade, affordable ultrasound portable devices for home healthcare treatment have become increasingly available to patients through the internet. Clinicians shouldn't ignore these devices, but instead seriously consider them as part of the solution for ultrasound therapy at high regimens.
Purpose: Synthesize the evidence of indications and dosages of ultrasound therapy for MSDs treated in physiotherapy practice and compare feasibility of implementing these recommendations between clinical devices and portable ones.
Methods: All systematic reviews and meta-analysis related to ultrasound therapy for MSDs commonly treated in physiotherapy using either clinical or portable devices published over the past 5 years in English or French were extracted from Medline and Embase. Quality of included reviews was assessed using AMSTAR. Isolated effects of ultrasound therapy applied either as a sole or adjunct intervention in comparison to placebo or most relevant intervention were extracted following a standard protocol. The level of evidence was determined based on the GRADE system. Clinical recommendations were then developed considering the level of evidence, direction and magnitude of effect. The APEASE criteria (Affordability, Practicability, Effectiveness/cost-effectiveness, Acceptability, Side-effects/safety, Equity) were used to compare feasibility to implement these recommendations between clinical and portable devices in either private or public practice settings.
Results: Ultrasound therapy demonstrates low and very low levels of evidence supporting its benefits in a limited number of MSDs following a dose-response pattern. Its main indication would be knee osteoarthritis using an intensive treatment regimen (min 3 x/week for 3 weeks). No reviews reported trials using portable devices for knee osteoarthritis or other MSDs. Based on the APEASE criteria, ensuring a proper patient education strategy, portable devices appear to be a safe approach with greater potential to meet ultrasound evidence-based dosimetry for knee osteoarthritis than clinical devices in either private or public practice settings. This is mainly explained by their higher affordability, cost-effectivness and practicability.
Conclusion(s): Ultrasound portable devices demonstrate higher potential than clinical devices to improve accessibility and therefore patient outcomes for MSDs commonly treated in physiotherapy practice. Especially for chronic conditions such as knee osteoarthritis for which evidence suggest that ultrasound therapy may be an effective adjunct treatment at high doses.
Implications: Physiotherapists should seriously consider prescribing home adjunct ultrasound therapy through portable devices in their shared decision-making process with patients presenting MSDs whom high dosage ultrasound therapy is indicated. Adhesion to home exercises programs, self-efficacy and satisfaction should be closely monitored by clinicians and researchers in order to better understand all the impacts of this innovative approach to care.
Funding, acknowledgements: None
Keywords: Ultrasound therapy, systematic review, self-care
Topic: Electrophysical & isothermal agents
Did this work require ethics approval? No
Institution: University of Montreal
Committee: CERES comité d'éthique de la recherche en santé
Reason: The study consists of a systematic review
All authors, affiliations and abstracts have been published as submitted.
