J Biol Regul Homeost Agents. 2018 Nov-Dec;32(6 Suppl. 1):23-28.
Biophysical stimulation of the knee with PEMFs: from bench to bedside.
Vicenti G1, Bizzoca D1, Nappi VS1, Moretti F2, Carrozzo M1, Belviso V1, Moretti B1.
Author information
1
Department of Neuroscience and Organs of Sense, Orthopaedics Section, University of Bari Aldo Moro, Bari, Italy.
2
National Center For Chemicals, Cosmetic Products And Consumer Protection, National Institute of Health, Rome, Italy.
Abstract
Clinical biophysics investigates the relationship between
non-ionizing physical energy and the human body. Although several types
of electrical stimulation devices have received US FDA approval for
orthopaedic application, the use of Pulsed Electromagnetic Field (PEMFs)
play a central role in joint biophysics. This narrative review aims to
summarize the current evidences on the efficacy of PEMF-therapy in the
treatment of knee articular diseases. Preclinical studies have assessed
the effects of PEMFs on chondrocytes, synoviocytes, articular cartilage
explants and animal models, showing positive effects of PEMF-therapy on
cells proliferation, extracellular matrix (ECM) production, chondrocytes
apoptosis and inflammatory cytokines down-regulation. Currently,
PEMF-therapy is a valid option in the conservative management of several
knee articular diseases, including early OA, patellofemoral pain
syndrome and SONK. PEMFs could be also used as an adjunct after an
arthroscopic knee procedure or TKA implantation, in order to control the
joint post-operative inflammatory state.
BMC Musculoskelet Disord. 2012 Jun 6;13(1):88. [Epub ahead of print]
I-ONE therapy in patients undergoing total knee arthroplasty: a prospective, randomized and controlled study.
Moretti B, Notarnicola A, Moretti L, Setti S, De Terlizzi F, Pesce V, Patella V.
Abstract
BACKGROUND:
Total knee arthroplasty (TKA) is often associated with a severe local
inflammatory reaction which, unless controlled, leads to persistent
pain up to one year after surgery. Standard and accelerated
rehabilitation protocols are currently being implemented after TKA, but
no consensus exists regarding the long-term effects. Biophysical
stimulation with pulsed electromagnetic fields (PEMFs) has been
demonstrated to exert an anti-inflammatory effect, to promote early
functional recovery and to maintain a positive long-term effect in
patients undergoing joint arthroscopy. The aim of this study was to
evaluate whether PEMFs can be used to limit the pain and enhance patient
recovery after TKA.
METHODS:
A prospective, randomized, controlled study in 30 patients undergoing
TKA was conducted. Patients were randomized into experimental PEMFs or a
control group. Patients in the experimental group were instructed to
use I-ONE stimulator 4hours/day for 60days. Postoperatively, all
patients received the same rehabilitation program. Treatment outcome was
assessed using the Knee Society Score, SF-36 Health-Survey and VAS.
Patients were evaluated pre-operatively and one, two, six and 12 months
after TKA. Joint swelling and Non Steroidal Anti Inflammatory Drug
(NSAID) consumption were recorded. Comparisons between the two groups
were carried out using a two-tail heteroschedastic Student’s t-test.
Analysis of variance for each individual subject during the study was
performed using ANOVA for multiple comparisons, applied on each group,
and a Dunnet post hoc test. A p value<0.05 was considered
statistically significant.
RESULTS:
Pre-operatively, no differences were observed between groups in terms
of age, sex, weight, height, Knee-Score, VAS, SF-36 and joint swelling,
with the exception of the Functional Score. The Knee-Score, SF-36 and
VAS demonstrated significantly positive outcomes in the I-ONE stimulated
group compared with the controls at follow-ups. In the I-ONE group,
NSAID use was reduced and joint swelling resolution was more rapid than
in controls. The effect of I-ONE therapy was maintained after use of the
device was discontinued.
CONCLUSIONS:
The results of the study show early functional recovery in the I-ONE
group. I-ONE therapy should be considered after TKA to prevent the
inflammatory reaction elicited by surgery, for pain relief and to speed
functional recovery.
Rheumatol Int. 2012 Mar 27. [Epub ahead of print]
Non-invasive electromagnetic field therapy produces rapid and
substantial pain reduction in early knee osteoarthritis: a randomized
double-blind pilot study.
Nelson FR, Zvirbulis R, Pilla AA.
Source
Department of Orthopaedic Surgery, Henry Ford Hospital, CFP 644, 2799 West Grand Blvd., Detroit, MI, 48202, USA, fnelson1@hfhs.org.
Abstract
This study examined whether a non-thermal, non-invasive, pulsed
electromagnetic field (PEMF), known to modulate the calmodulin
(CaM)-dependent nitric oxide (NO)/cyclic guanosine monophosphate (cGMP)
signaling pathway, could reduce pain in early knee OA. This randomized,
placebo-controlled, double-blind pilot clinical study enrolled 34
patients. Patient selection required initial VAS ?4, 2 h of standing
activity per day, and no recent interventions such as cortisone
injections or surgery. Results showed VAS pain score decreased in the
active cohort by 50 ± 11 % versus baseline starting at day 1 and
persisting to day 42 (P < 0.001). There was no significant decrease
in VAS versus baseline at any time point in the sham cohort (P = 0.227).
The overall decrease in mean VAS score for the active cohort was nearly
threefold that of the sham cohort (P < 0.001). The results suggest
that non-thermal, non-invasive PEMF therapy can have a significant and
rapid impact on pain from early knee OA and that larger clinical trials
are warranted.
J Rehabil Med. 2009 Nov;41(13):1090-5.
Effect of biomagnetic therapy versus physiotherapy for treatment of knee osteoarthritis: a randomized controlled trial.
Gremion G, Gaillard D, Leyvraz PF, Jolles BM.
Department of Orthopaedic Surgery (DAL), Centre Hospitalier
Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.
Abstract
OBJECTIVE: To assess the effectiveness of pulsed signal therapy in the treatment of knee osteoarthritis (Kellgren II or III).
METHODS: A randomized, double-blind controlled clinical trial. The
first 95 patients sent to the clinic with knee osteo-arthritis were
selected and randomized into treatment with pulsed signal therapy or
conventional physiotherapy. Assessment included recording of usual
demographic data, pertinent history, baseline medication and
radiographs. Clinical evaluation was made at baseline, 6 weeks and 6
months after the end of treatment by the same blinded doctor. At each
follow-up time, the patient was asked to complete a visual analogue pain
scale and a Lequesne score. The doctor recorded the degree of pain on
motion and the ability to move the affected knee.
RESULTS: Both treatments resulted in significant improvements in pain
and physical function. A statistical difference was observed only for
activities of daily living, where the physiotherapy was more efficient
(p<0.03). The cost of treatment with pulsed signal therapy was
significantly higher, double the treatment cost of conventional
physiotherapy.
CONCLUSION: Like physiotherapy, pulsed signal therapy has improved
the clinical state of treated patients but with no significant
statistical difference. Pulsed signal therapy is, however, more
expensive.
J Rehabil Med. 2009 May;41(6):406-11.
Effectiveness of pulsed electromagnetic field therapy in the
management of osteoarthritis of the knee: a meta-analysis of randomized
controlled trials.
Vavken P, Arrich F, Schuhfried O, Dorotka R.
Department of Orthopedic Surgery, Children’s Hospital Boston, 300 Longwood Avenue, Enders 1016, Boston, MA 02115, USA.
Patrick.vavken@childrens.harvard.edu
Abstract
OBJECTIVE: To assess the effectiveness of pulsed electromagnetic
fields compared with placebo in the management of osteoarthritis of the
knee.
DATA SOURCES: A systematic review of PubMed, EMBASE, and the Cochrane Controlled Trials Register.
METHODS: Randomized, controlled trials reporting on the blinded
comparison of pulsed electromagnetic fields with placebo were included.
Validity was tested according to the Jadad Scale. Studies were pooled
using fixed-effects and random-effects models after exclusion of
publication bias and assessment of heterogeneity. Sensitivity analyses
and meta-regression were performed to test the stability of our
findings.
RESULTS: Nine studies, including 483 patients, were pooled. No
significant difference could be shown for pain (weighted mean difference
0.2 patients; 95% confidence interval (CI): -0.4 to 0.8) or stiffness
(weighted mean difference 0.3; 95% CI: -0.3 to 0.9). There was a
significant effect on activities of daily living (weighted mean
difference 0.8; 95% CI 0.2-1.4, p = 0.014) and scores (standardized mean
difference 0.4; 95% CI: 0.05-0.8, p = 0.029). We saw only statistically
insignificant differences between studies with different treatment
protocols.
CONCLUSION: Pulsed electromagnetic fields improve clinical scores and
function in patients with osteoarthritis of the knee and should be
considered as adjuvant therapies in their management. There is still
equipoise of evidence for an effect on pain in the current literature.
Rheumatol Int. 2009 Apr;29(6):663-6. Epub 2008 Nov 18.
The effects of pulsed electromagnetic fields in the treatment of knee osteoarthritis: a randomized, placebo-controlled trial.
Ay S, Evcik D.
Department of Physical Medicine and Rehabilitation, Ufuk University
School of Medicine Doctor Ridvan Ege Hospital, Balgat, 06520, Ankara,
Turkey.saimeay@yahoo.com
Abstract
In this study, we planned to investigate the effects of pulse
electromagnetic field (PEMF) on pain relief and functional capacity of
patients with knee osteoarthritis (OA). Fifty-five patients with knee OA
were included in a randomized, placebo-controlled study. At the end of
the therapy, there was statistically significant improvement in pain
scores in both groups (P < 0.05). However, no significant difference
was observed within the groups (P > 0.05). We observed statistically
significant improvement in some of the subgroups of Lequesne index.
These are morning stiffness and activities of daily living activities
compared to placebo group. However, we could not observe statistically
significant differences in total of the scale between two groups (P >
0.05). Applying between-group analysis, we were unable to demonstrate a
beneficial symptomatic effect of PEMF in the treatment of knee OA in
all patients. Further studies using different types of magnetic devices,
treatment protocols and patient populations are warranted to confirm
the general efficacy of PEMF therapy in OA and other conditions.
Knee Surg Sports Traumatol Arthrosc. 2007 Jul;15(7):830-4. Epub 2007 Feb 28.
Effects of pulsed electromagnetic fields on patients’ recovery after
arthroscopic surgery: prospective, randomized and double-blind study.
Zorzi C, Dall’Oca C, Cadossi R, Setti S.
“Sacro Cuore Don Calabria” Hospital, Via don A. Sempreboni 5, 37024 Negrar (Vr), Italy.
Abstract
Severe joint inflammation following trauma, arthroscopic surgery or
infection can damage articular cartilage, thus every effort should be
made to protect cartilage from the catabolic effects of pro-inflammatory
cytokines and stimulate cartilage anabolic activities. Previous
pre-clinical studies have shown that pulsed electromagnetic fields
(PEMFs) can protect articular cartilage from the catabolic effects of
pro-inflammatory cytokines, and prevent its degeneration, finally
resulting in chondroprotection. These findings provide the rational to
support the study of the effect of PEMFs in humans after arthroscopic
surgery. The purpose of this pilot, randomized, prospective and
double-blind study was to evaluate the effects of PEMFs in patients
undergoing arthroscopic treatment of knee cartilage. Patients with knee
pain were recruited and treated by arthroscopy with chondroabrasion
and/or perforations and/or radiofrequencies. They were randomized into
two groups: a control group (magnetic field at 0.05 mT) and an active
group (magnetic field of 1.5 mT). All patients were instructed to use
PEMFs for 90 days, 6 h per day. The patients were evaluated by the Knee
injury and Osteoarthritis Outcome Score (KOOS) test before arthroscopy,
and after 45 and 90 days. The use of non-steroidal anti-inflammatory
drugs (NSAIDs) to control pain was also recorded. Patients were
interviewed for the long-term outcome 3 years after arthroscopic
surgery. Thirty-one patients completed the treatment. KOOS values at 45
and 90 days were higher in the active group and the difference was
significant at 90 days (P < 0.05). The percentage of patients who
used NSAIDs was 26% in the active group and 75% in the control group (P =
0.015). At 3 years follow-up, the number of patients who completely
recovered was higher in the active group compared to the control group
(P < 0.05). Treatment with I-ONE aided patient recovery after
arthroscopic surgery, reduced the use of NSAIDs, and also had a positive
long-term effect.
BMC Musculoskelet Disord. 2007 Jun 22;8:51.
Short-term efficacy of physical interventions in osteoarthritic knee
pain. A systematic review and meta-analysis of randomised
placebo-controlled trials.
Bjordal JM, Johnson MI, Lopes-Martins RA, Bogen B, Chow R, Ljunggren AE.
Faculty of Health and Social Sciences, Institute of Physiotherapy, Bergen University College, Moellendalsvn, Bergen Norway. jmb@hib.no
Abstract
BACKGROUND: Treatment efficacy of physical agents in osteoarthritis
of the knee (OAK) pain has been largely unknown, and this systematic
review was aimed at assessing their short-term efficacies for pain
relief.
METHODS: Systematic review with meta-analysis of efficacy within 1-4
weeks and at follow up at 1-12 weeks after the end of treatment.
RESULTS: 36 randomised placebo-controlled trials (RCTs) were
identified with 2434 patients where 1391 patients received active
treatment. 33 trials satisfied three or more out of five methodological
criteria (Jadad scale). The patient sample had a mean age of 65.1 years
and mean baseline pain of 62.9 mm on a 100 mm visual analogue scale
(VAS). Within 4 weeks of the commencement of treatment manual
acupuncture, static magnets and ultrasound therapies did not offer
statistically significant short-term pain relief over placebo. Pulsed
electromagnetic fields offered a small reduction in pain of 6.9 mm [95%
CI: 2.2 to 11.6] (n = 487). Transcutaneous electrical nerve stimulation
(TENS, including interferential currents), electro-acupuncture (EA) and
low level laser therapy (LLLT) offered clinically relevant pain
relieving effects of 18.8 mm [95% CI: 9.6 to 28.1] (n = 414), 21.9 mm
[95% CI: 17.3 to 26.5] (n = 73) and 17.7 mm [95% CI: 8.1 to 27.3] (n =
343) on VAS respectively versus placebo control. In a subgroup analysis
of trials with assumed optimal doses, short-term efficacy increased to
22.2 mm [95% CI: 18.1 to 26.3] for TENS, and 24.2 mm [95% CI: 17.3 to
31.3] for LLLT on VAS. Follow-up data up to 12 weeks were sparse, but
positive effects seemed to persist for at least 4 weeks after the course
of LLLT, EA and TENS treatment was stopped.
BMC Musculoskelet Disord. 2006 Jun 15;7:51.
Pulsed electromagnetic energy treatment offers no clinical benefit
in reducing the pain of knee osteoarthritis: a systematic review.
McCarthy CJ, Callaghan MJ, Oldham JA.
Warwick Emergency Care and Rehabilitation, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK. C.J.McCarthy@warwick.ac.uk
Abstract
BACKGROUND: The rehabilitation of knee osteoarthritis often includes
electrotherapeutic modalities as well as advice and exercise. One
commonly used modality is pulsed electromagnetic field therapy (PEMF).
PEMF uses electro magnetically generated fields to promote tissue repair
and healing rates. Its equivocal benefit over placebo treatment has
been previously suggested however recently a number of randomised
controlled trials have been published that have allowed a systematic
review to be conducted.
METHODS: A systematic review of the literature from 1966 to 2005 was
undertaken. Relevant computerised bibliographic databases were searched
and papers reviewed independently by two reviewers for quality using
validated criteria for assessment. The key outcomes of pain and
functional disability were analysed with weighted and standardised mean
differences being calculated.
RESULTS: Five randomised controlled trials comparing PEMF with
placebo were identified. The weighted mean differences of the five
papers for improvement in pain and function, were small and their 95%
confidence intervals included the null.
CONCLUSION: This systematic review provides further evidence that
PEMF has little value in the management of knee osteoarthritis. There
appears to be clear evidence for the recommendation that PEMF does not
significantly reduce the pain of knee osteoarthritis.
Z Orthop Ihre Grenzgeb. 2005 Sep-Oct;143(5):544-50.
Adjuvant treatment of knee osteoarthritis with weak pulsing magnetic
fields. Results of a placebo-controlled trial prospective clinical
trial.
[Article in German]
Fischer G, Pelka RB, Barovic J.
Institut für Hygiene an der Universität Graz, Osterreich.
Abstract
PURPOSE: The aim of this study was the objective control of the
therapeutic effect of weak pulsing magnetic fields (series of
periodically repeating square pulses increasing according to an
e-function, frequencies of 10, 20, 30, and 200-300 Hz) by means of a
double-blind study on osteoarthritis of the knee. Measured parameters
were the Knee Society score, pain sensation, blood count and
cardiocirculatory values.
METHODS: 36 placebo and 35 verum test persons (all with a knee gap
smaller than 3 mm) were exposed daily for 16 minutes over 6 weeks to a
low frequency magnetic field (flux densities increasing gradually from
3.4 up to 13.6 microT) encompassing the whole body. The last data
collection was made 4 weeks after the end of treatment.
RESULTS: Principally, the statistically ensured results exclusively
favour the used magnetic field therapy; by far the greatest number of at
least significant differences was found at the end of the whole
treatment, lasting 6 weeks. In particular, it is striking that all 4
questioned pain scales showed at least significant improvements in
favour of the verum collective; also the walking distance was increased.
As another confirmed fact, even after 4 weeks without therapy the
persistence of several functional and analgesic effects could be
documented.
CONCLUSIONS: Predominantly, on the one hand, pain relief in
osteoarthritis patients was confirmed by a double-blind trial, on the
other hand, increases in mobility could be proven. Furthermore, we
describe mainly the modes of action of low frequency magnetic energy and
3 physical concepts that are seen as the connecting link between
electromagnetic fields coupled into connective tissue and biochemical
repair and growth processes in bones and cartilage. Proceeding from the
results of this and preceding studies, one has to consider seriously
whether this kind of magnetic field application should not be employed
as cost-effective and side effect-free alternative or adjuvant form of
therapy in the field of orthopaedic disorders.
| Osteoarthritis Cartilage. 2005 Jul;13(7):575-81. |
Treatment of knee osteoarthritis with pulsed electromagnetic fields: a randomized, double-blind, placebo-controlled study.
Thamsborg G, Florescu A, Oturai P, Fallentin E, Tritsaris K, Dissing S.
Department of Geriatri and Rheumatology, Glostrup Hospital, 2600 Glostrup, Denmark.
OBJECTIVE: The investigation aimed at determining the effectiveness
of pulsed electromagnetic fields (PEMF) in the treatment of
osteoarthritis (OA) of the knee by conducting a randomized,
double-blind, placebo-controlled clinical trial.
DESIGN: The trial consisted of 2h daily treatment 5 days per week for
6 weeks in 83 patients with knee OA. Patient evaluations were done at
baseline and after 2 and 6 weeks of treatment. A follow-up evaluation
was done 6 weeks after treatment. Activities of daily living (ADL), pain
and stiffness were evaluated using the Western Ontario and McMaster
Universities (WOMAC) questionnaire.
RESULTS: Within group analysis revealed a significant improvement in
ADL, stiffness and pain in the PEMF-treated group at all evaluations. In
the control group there was no effect on ADL after 2 weeks and a weak
significance was seen after 6 and 12 weeks. Significant effects were
seen on pain at all evaluations and on stiffness after 6 and 12 weeks.
Between group analysis did not reveal significant improvements over
time. Analysis of ADL score for the PEMF-treated group revealed a
significant correlation between less improvement and increasing age.
Analysis of patients <65 years using between group analysis revealed a
significant improvement for stiffness on treated knee after 2 weeks,
but this effect was not observed for ADL and pain.
CONCLUSIONS: Applying between group analysis we were unable to
demonstrate a beneficial symptomatic effect of PEMF in the treatment of
knee OA in all patients. However, in patients <65 years of age there
is significant and beneficial effect of treatment related to stiffness
| J Orthop Res. 2005 Jul;23(4):899-908. Epub 2005 Mar 17. |
Pulsed electromagnetic fields reduce knee osteoarthritic lesion progression in the aged Dunkin Hartley guinea pig.
Fini M, Giavaresi G, Torricelli P, Cavani F, Setti S, Cane V, Giardino R.
Department of Experimental Surgery, Codivilla-Putti Research
Institute, Rizzoli Institute of Orthopaedics, Via di Barbiano, 1/10,
40136 Bologna, Italy. milena.fini@ior.it
An experimental in vivo study was performed to test if the effect of
Pulsed Electromagnetic Fields (PEMFs) on chondrocyte metabolism and
adenosine A2a agonist activity could have a chondroprotective effect on
the knee of Dunkin Hartley guinea-pigs of 12 months with spontaneously
developed osteoarthritis (OA). After a pilot study, 10 animals were
randomly divided into two groups: PEMF-treated group (6 h/day for 3
months) and Sham-treated group. Microradiography and histomorphometry
were performed on the entire articular surface of knee joints used in
evaluating chondropathy severity, cartilage thickness (CT), cartilage
surface Fibrillation Index (FI), subchondral bone plate thickness (SBT)
and histomorphometric characteristics of trabecular epiphyseal bone. The
PEMF-treated animals showed a significant reduction of chondropathy
progression in all knee examined areas (p<0.05). CT was significantly
higher (p<0.001) in the medial tibia plateaus of the PEMF-treated
group when compared to the Sham-treated group. The highest value of FI
was observed in the medial tibia plateau of the Sham-treated group
(p<0.05). Significant lower values were observed in SBT of
PEMF-treated group in comparison to Sham-treated group in all knee
examined areas (p<0.05). The present study results show that PEMFs
preserve the morphology of articular cartilage and slower the
progression of OA lesions in the knee of aged osteoarthritic guinea
pigs. The chondroprotective effect of PEMFs was demonstrated not only in
the medial tibial plateau but also on the entire articular surface of
the knee.
| Clin Exp Rheumatol. 2004 Sep-Oct;22(5):568-72. |
Efficacy and safety of a musically modulated electromagnetic field (TAMMEF) in patients affected by knee osteoarthritis.
Battisti E, Piazza E, Rigato M, Nuti R, Bianciardi L, Scribano A, Giordano N.
Department of Medical Physics, University of Siena, Italy.battistie@unisi.it
OBJECTIVE: Numerous studies have demonstrated the utility of
extremely low frequencies (ELF) electromagnetic fields in clinical
practice. Moreover, the effects of these fields seems to depend on their
respective codes (frequency, intensity, waveform). In our study we want
to value the effects of the TAMMEF (Therapeutic Application of a
Musically Modulated Electromagnetic Field) system, which field is
piloted by a musical signal.
METHODS: Ninety subjects, affected by primary osteoarthritis of the
knee, were enrolled in the study and randomly divided into three groups
of 30 patients each: A exposed to TAMMEF, B exposed to ELF, C exposed to
a simulated field. All subjects underwent a cycle of 15 daily sessions
of 30 minutes each and a clinical examination upon enrolment, after 7
days of therapy, at the end of the cycle and at a follow-up 30 days
later:
RESULTS: All the patients of groups A and B completed the therapy
without the appearance of side effects: they presented a significant
improvement of the subjective pain and the functional limitation, which
remained stable at the follow-up examination. In group C, there was no
improvement of the pain symptoms or articular functionality.
CONCLUSIONS: This study suggests that the TAMMEF system is
efficacious in the control of pain symptoms and in the reduction of
functional limitation in patients with knee osteoarthritis. Moreover,
the effects of the TAMMEF system cover those produced by the ELF field.
| Altern Ther Health Med. 2004 Mar-Apr;10(2):36-43. |
Double-blind placebo-controlled trial of static magnets for the
treatment of osteoarthritis of the knee: results of a pilot study.
Wolsko PM, Eisenberg DM, Simon LS, Davis RB, Walleczek J, Mayo-Smith M, Kaptchuk TJ, Phillips RS.
Division for Research and Education, Harvard Medical School, Boston, MA, USA.
CONTEXT: Outpatient clinical studies of magnet therapy, a
complementary therapy commonly used to treat osteoarthritis (OA), have
been limited by the absence of a credible placebo control.
OBJECTIVE: Our objective was to assess the feasibility and promise of
studying static magnetic therapy for knee OA and determine the ability
of a new placebo-magnet device to provide concealment of group
assignment.
DESIGN: Randomized, double-blind, placebo-controlled clinical trial.
SETTING: Academic teaching hospital in Boston.
PARTICIPANTS: We enrolled 29 subjects with idiopathic or post-traumatic OA of the knee.
INTERVENTIONS: Subjects received either high-strength magnetic
(active) or placebo-magnetic (placebo) knee sleeve treatment for 4 hours
in a monitored setting and self-treatment 6 hours daily for 6 weeks.
MAIN OUTCOME MEASURES: Primary outcomes were change in knee pain as
measured by the WOMAC Osteoarthritis Index Pain Subscale at 6 weeks and
extent of group concealment at study end. RESULTS: At 4 hours, VAS pain
scores (+/- SE) on a 5-item scale (0-500, 500 worst) decreased 79 +/- 18
mm in the active group and 10 +/- 21 mm in the placebo group (P <
0.05). There were no significant differences in any primary or secondary
measure of efficacy between the treatment groups at 6 weeks. Despite
widespread testing for magnetic properties, at study end, 69% of the
active group and 77% of the placebo group (P > 0.2) believed that
they had been assigned to the active treatment group.
CONCLUSION: Despite our small sample size, magnets showed
statistically significant efficacy compared to placebo after 4 hours
under rigorously controlled conditions. The sustained efficacy of
magnetic therapy for knee osteoarthritis could be assessed in an
adequately powered trial utilizing an appropriate control such our new
placebo-magnet device.
| Altern Ther Health Med. 2002 Jul-Aug;8(4):50-5. |
Effects of static magnets on chronic knee pain and physical function: a double-blind study.
Hinman MR, Ford J, Heyl H.
Department of Physical Therapy, University of Texas Medical Branch, Galveston, USA.
CONTEXT: Static magnets have become an increasingly popular
alternative therapy for individuals with musculoskeletal pain despite
limited scientific evidence to support their efficacy or safety.
OBJECTIVE: To determine the effects of static magnets on the pain and
functional limitations associated with chronic knee pain due to
degenerative joint disease.
DESIGN: Double-blind, randomized, controlled clinical trial.
SETTING: Pretests and posttests were conducted in an academic health science center.
PARTICIPANTS: Forty-three ambulatory subjects with chronic pain in 1
or both knee joints who were recruited from outpatient clinics or who
volunteered to participate.
INTERVENTION: Subjects wore pads containing magnets or placebos over their painful knee joints for 2 weeks.
MAIN OUTCOME MEASURES: Self-administered ratings of pain and physical
function using the Western Ontario and McMaster Universities
Osteoarthritis Index (WOMAC) and a timed 15-m (50-ft) walk.
RESULTS: Multivariate analysis of covariance revealed significantly
greater improvements in the group wearing magnets (P=.002). Univariate
analyses indicated that comparative changes in self-rated pain and
physical function (P=.002 and .001, respectively) were greater than
changes in gait speed (P=.042).
CONCLUSIONS: The application of static magnets over painful knee
joints appears to reduce pain and enhance functional movement. However,
further study is needed to determine the physiological mechanisms
responsible for this analgesic effect.
Cochrane Database Syst Rev. 2002;(1):CD003523.
Electromagnetic fields for the treatment of osteoarthritis.
Hulme J, Robinson V, DeBie R, Wells G, Judd M, Tugwell P.
Cochrane Collaborating Center, Center for Global Health, Institute of
Population Health – University of Ottawa, 1 Stewart Street, Ottawa,
Ontario, Canada, K1N 6N5. jhulme@uottawa.ca
BACKGROUND: As the focus for osteoarthritis (OA) treatment shifts
away from drug therapy, we consider the effectiveness of pulsed electric
stimulation which is proven to stimulate cartilage growth on the
cellular level.
OBJECTIVES: 1)To assess the effectiveness of pulsed electric
stimulation for the treatment of osteoarthritis (OA). 2) To assess the
most effective and efficient method of applying an electromagnetic
field, through pulsed electromagnetic fields (PEMF) or electric
stimulation, as well as the consideration of length of treatment,
dosage, and the frequency of the applications.
SEARCH STRATEGY: We searched PREMEDLINE, MEDLINE, HealthSTAR, CINAHL,
PEDro, and the Cochrane Controlled Trials Register (CCTR) up to and
including 2001. This included searches through the coordinating offices
of the trials registries of the Cochrane Field of Physical and Related
Therapies and the Cochrane Musculoskeletal Group for further published
and unpublished articles. The electronic search was complemented by hand
searches and experts in the area.
SELECTION CRITERIA: Randomized controlled trials and controlled
clinical trials that compared PEMF or direct electric stimulation
against placebo in patients with OA.
DATA COLLECTION AND ANALYSIS: Two reviewers determined the studies to
be included in the review based on inclusion and exclusion criteria
(JH,VR) and extracted the data using pre-developed extraction forms for
the Cochrane Musculoskeletal Group. The methodological quality of the
trials was assessed by the same reviewers using a validated scale (Jadad
1996). Osteoarthritis outcome measures were extracted from the
publications according to OMERACT guidelines (Bellamy 1997) and
additional secondary outcomes considered.
MAIN RESULTS: Only three studies with a total of 259 OA patients were
included in the review. Electrical stimulation therapy had a small to
moderate effect on outcomes for knee OA, all statistically significant
with clinical benefit ranging from 13-23% greater with active treatment
than with placebo. Only 2 outcomes for cervical OA were significantly
different with PEMF treatment and no clinical benefit can be reported
with changes of 12% or less.
REVIEWER’S CONCLUSIONS: Current evidence suggests that electrical
stimulation therapy may provide significant improvements for knee OA,
but further studies are required to confirm whether the statistically
significant results shown in these trials confer to important benefits.
|
Wien Klin Wochenschr. 2002 Aug 30;114(15-16):678-84.
Pulsed magnetic field therapy for osteoarthritis of the knee–a double-blind sham controlled trial.
Nikolakis P, Kollmitzer J, Crevenna R, Bitter C, Erdogmus CB, Nikolakis J.
Department of Physical Medicine and Rehabilitation, AKH Wien, University of Vienna, Vienna, Austria. Peter.nicolakis@akh-wien.ac.at
BACKGROUND AND METHODS: Pulsed magnetic field therapy is frequently
used to treat the symptoms of osteoarthritis, although its efficacy has
not been proven. We conducted a randomized, double-blind comparison of
pulsed magnetic field and sham therapy in patients with symptomatic
osteoarthritis of the knee. Patients were assigned to receive 84
sessions, each with a duration of 30 minutes, of either pulsed magnetic
field or sham treatment. Patients administered the treatment on their
own at home, twice a day for six weeks.
RESULTS: According to a sample size estimation, 36 consecutive
patients were enrolled. 34 patients completed the study, two of whom had
to be excluded from the statistical analysis, as they had not applied
the PMF sufficiently. Thus, 15 verum and 17 sham-treated patients were
enrolled in the statistical analysis. After six weeks of treatment the
WOMAC Osteoarthritis Index was reduced in the pulsed magnetic
field-group from 84.1 (+/- 45.1) to 49.7 (+/- 31.6), and from 73.7 (+/-
43.3) to 66.9 (+/- 52.9) in the sham-treated group (p = 0.03). The
following secondary parameters improved in the pulsed magnetic field
group more than they did in the sham group: gait speed at fast walking
[+6.0 meters per minute (1.6 to 10.4) vs. -3.2 (-8.5 to 2.2)], stride
length at fast walking [+6.9 cm (0.2 to 13.7) vs. -2.9 (-8.8 to 2.9)],
and acceleration time in the isokinetic dynamometry strength tests
[-7.0% (-15.2 to 1.3) vs. 10.1% (-0.3 to 20.6)].
CONCLUSION: In patients with symptomatic osteoarthritis of the knee,
PMF treatment can reduce impairment in activities of daily life and
improve knee function.
Arch Phys Med Rehabil. 2001 Oct;82(10):1453-60.
Two configurations of static magnetic fields for treating rheumatoid arthritis of the knee: a double-blind clinical trial.
Segal NA, Toda Y, Huston J, Saeki Y, Shimizu M, Fuchs H, Shimaoka Y, Holcomb R, McLean MJ.
Vanderbilt University Medical School, Nashville, TN 37232, USA.
Abstract
OBJECTIVE: To assess the efficacy of a nonpharmacologic, noninvasive
static magnetic device as adjunctive therapy for knee pain in patients
with rheumatoid arthritis (RA).
DESIGN: Randomized, double-blind, controlled, multisite clinical trial.
SETTING: An American and a Japanese academic medical center as well as 4 community rheumatology and orthopedics practices.
PATIENTS: Cohort of 64 patients over age 18 years with rheumatoid
arthritis and persistent knee pain, rated greater than 40/100mm, despite
appropriate use of medications.
INTERVENTION: Four blinded MagnaBloc (with 4 steep field gradients)
or control devices (with 1 steep field gradient) were taped to a knee of
each subject for 1 week.
MAIN OUTCOME MEASURES: The American College of Rheumatology
recommended core set of disease activity measures for RA clinical trials
and subjects’ assessment of treatment outcome.
RESULTS: Subjects randomly assigned to the MagnaBloc (n = 38) and
control treatment groups (n = 26) reported baseline pain levels of
63/100mm and 61/100mm, respectively. A greater reduction in reported
pain in the MagnaBloc group was sustained through the 1-week follow-up
(40.4% vs 25.9%) and corroborated by twice daily pain diary results (p
< .0001 for each vs baseline). However, comparison between the 2
groups demonstrated a statistically insignificant difference (p <
.23). Subjects in the MagnaBloc group reported an average decrease in
their global assessment of disease activity of 33% over 1 week, as
compared with a 2% decline in the control group (p < .01). After 1
week, 68% of the MagnaBloc treatment group reported feeling better or
much better, compared with 27% of the control group, and 29% and 65%,
respectively, reported feeling the same as before treatment (p <
.01).
CONCLUSIONS: Both devices demonstrated statistically significant pain
reduction in comparison to baseline, with concordance across multiple
indices. However, a significant difference was not observed between the 2
treatment groups (p < .23). In future studies, the MagnaBloc
treatment should be compared with a nonmagnetic placebo treatment to
characterize further its therapeutic potential for treating RA. This
study did elucidate methods for conducting clinical trials with magnetic
devices.
Curr Med Res Opin. 2001;17(3):190-6.
Magnetic pulse treatment for knee osteoarthritis: a randomised, double-blind, placebo-controlled study.
Pipitone N, Scott DL.
Rheumatology Department, King’s College Hospital (Dulwich), London, UK.
Abstract
We assessed the efficacy and tolerability of low-frequency pulsed
electromagnetic fields (PEMF) therapy in patients with clinically
symptomatic knee osteoarthritis (OA) in a randomised,
placebo-controlled, double-blind study of six weeks’ duration. Patients
with radiographic evidence and symptoms of OA (incompletely relieved by
conventional treatments), according to the criteria of the American
College of Rheumatology, were recruited from a single tertiary referral
centre. 75 patients fulfilling the above criteria were randomised to
receive active PEMF treatment by unipolar magnetic devices (Medicur)
manufactured by Snowden Healthcare (Nottingham, UK) or placebo. Six
patients failed to attend after the screening and were excluded from
analysis. The primary outcome measure was reduction in overall pain
assessed on a four-point Likert scale ranging from nil to severe.
Secondary outcome measures included the WOMAC Osteoarthritis Index
(Likert scale) and the EuroQol (Euro-Quality of Life, EQ-5D). Baseline
assessments showed that the treatment groups were equally matched.
Although there were no significant differences between active and sham
treatment groups in respect of any outcome measure after treatment,
paired analysis of the follow-up observations on each patient showed
significant improvements in the actively treated group in the WOMAC
global score (p = 0.018), WOMAC pain score (p = 0.065), WOMAC disability
score (p = 0.019) and EuroQol score (p = 0.001) at study end compared
to baseline. In contrast, there were no improvements in any variable in
the placebo-treated group. There were no clinically relevant adverse
effects attributable to active treatment. These results suggest that the
Medicur unipolar magnetic devices are beneficial in reducing pain and
disability in patients with knee OA resistant to conventional treatment
in the absence of significant side-effects. Further studies using
different types of magnetic devices, treatment protocols and patient
populations are warranted to confirm the general efficacy of PEMF
therapy in OA and other conditions.
Altern Ther Health Med. 2001 Sep-Oct;7(5):54-64, 66-9.
Low-amplitude, extremely low frequency magnetic fields for the treatment of osteoarthritic knees: a double-blind clinical study.
Jacobson JJ, Gorman R, Yamanashi WS, Saxena BB, Clayton L.
Institute of Theoretical Physics and Advanced Studies for Biophysical
Research, Perspectivism Foundation, 2006 Mainsail Cir, Jupiter, FL
33477-1418, USA. drjjacobson@aol.com
CONTEXT: Noninvasive magnetotherapeutic approaches to bone healing have been successful in past clinical studies.
OBJECTIVE: To determine the effectiveness of low-amplitude, extremely
low frequency magnetic fields on patients with knee pain due to
osteoarthritis.
DESIGN: Placebo-controlled, randomized, double-blind clinical study.
SETTING: 4 outpatient clinics.
PARTICIPANTS: 176 patients were randomly assigned to 1 of 2 groups,
the placebo group (magnet off) or the active group (magnet on).
INTERVENTION: 6-minute exposure to each magnetic field signal using 8
exposure sessions for each treatment session, the number of treatment
sessions totaling 8 during a 2-week period, yielded patients being
exposed to uniform magnetic fields for 48 minutes per treatment session 8
times in 2 weeks. The magnetic fields used in this study were generated
by a Jacobson Resonator, which consists of two 18-inch diameter (46-cm
diameter) coils connected in series, in turn connected to a function
generator via an attenuator to obtain the specific amplitude and
frequency. The range of magnetic field amplitudes used was from 2.74 x
10(-7) to 3.4 x 10(-8) G, with corresponding frequencies of 7.7 to 0.976
Hz.
OUTCOME MEASURES: Each subject rated his or her pain level from 1
(minimal) to 10 (maximal) before and after each treatment and 2 weeks
after treatment. Subjects also recorded their pain intensity in a diary
while outside the treatment environment for 2 weeks after the last
treatment session (session 8) twice daily: upon awakening (within 15
minutes) and upon retiring (just before going to bed at night).
RESULTS: Reduction in pain after a treatment session was
significantly (P < .001) greater in the magnet-on group (46%)
compared to the magnet-off group (8%).
CONCLUSION: Low-amplitude, extremely low frequency magnetic fields
are safe and effective for treating patients with chronic knee pain due
to osteoarthritis.
J Spinal Cord Med. 1999 Winter;22(4):239-45.
The effect of pulsed electromagnetic fields on osteoporosis at the knee in individuals with spinal cord injury.
Garland DE, Adkins RH, Matsuno NN, Stewart CA.
Rancho Los Amigos Medical Center, Downey, California 90242, USA.
Abstract
The purpose of this study was to determine the effects of pulsed
electromagnetic fields on osteoporotic bone at the knee in individuals
with chronic spinal injury. The study consisted of 6 males with complete
spinal cord injury at a minimum of 2 years duration. Bone mineral
density (BMD) was obtained at both knees at initiation, 3 months, 6
months, and 12 months using dual energy X-ray absorptiometry. In each
case, 1 knee was stimulated using The Bone Growth Stimulator Model 3005
from American Medical Electronics, Incorporated and the opposite knee
served as the control. Stimulation ceased at 6 months. At 3 months BMD
increased in the stimulated knees 5.1% and declined in the control knees
6.6% (p < .05 and p < .02, respectively). By 6 months the BMD
returned to near baseline values and at 12 months both knees had lost
bone at a similar rate to 2.4% below baseline for the stimulated knee
and 3.6% below baseline for the control. There were larger effects
closer to the site of stimulation. While the stimulation appeared useful
in retarding osteoporosis, the unexpected exaggerated decline in the
control knees and reversal at 6 months suggests underlying mechanisms
are more complex than originally anticipated. The authors believe a
local as well as a systemic response was created.
Rheumatol. 1994 Oct;21(10):1903-11.
The effect of pulsed electromagnetic fields in the treatment of
osteoarthritis of the knee and cervical spine. Report of randomized,
double blind, placebo controlled trials.
Trock DH, Bollet AJ, Markoll R.
Department of Medicine, Danbury Hospital, CT.
OBJECTIVE. We conducted a randomized, double blind clinical trial to
determine the effectiveness of pulsed electromagnetic fields (PEMF) in
the treatment of osteoarthritis (OA) of the knee and cervical spine.
METHODS. A controlled trial of 18 half-hour active or placebo
treatments was conducted in 86 patients with OA of the knee and 81
patients with OA of the cervical spine, in which pain was evaluated
using a 10 cm visual analog scale, activities of daily living using a
series of questions (answered by the patient as never, sometimes, most
of the time, or always), pain on passive motion (recorded as none,
slight, moderate, or severe), and joint tenderness (recorded using a
modified Ritchie scale). Global evaluations of improvement were made by
the patient and examining physician. Evaluations were made at baseline,
midway, end of treatment, and one month after completion of treatment.
RESULTS. Matched pair t tests showed extremely significant changes
from baseline for the treated patients in both knee and cervical spine
studies at the end of treatment and the one month followup observations,
whereas the changes in the placebo patients showed lesser degrees of
significance at the end of treatment, and had lost significance for most
variables at the one month followup. Means of the treated group of
patients with OA of the knee showed greater improvement from baseline
values than the placebo group by the end of treatment and at the one
month followup observation. Using the 2-tailed t test, at the end of
treatment the differences in the means of the 2 groups reached
statistical significance for pain, pain on motion, and both the patient
overall assessment and the physician global assessment. The means of the
treated patients with OA of the cervical spine showed greater
improvement from baseline than the placebo group for most variables at
the end of treatment and one month followup observations; these
differences reached statistical significance at one or more observation
points for pain, pain on motion, and tenderness.
CONCLUSION. PEMF has therapeutic benefit in painful OA of the knee or cervical spine.
Altern Ther Health Med. 2001 Sep-Oct;7(5):54-64, 66-9.
Low-amplitude, extremely low frequency magnetic fields for the treatment of osteoarthritic knees: a double-blind clinical study.
Jacobson J. et.al. Inst. for Biophysical Research, Jupiter, FL, USA
CONTEXT: Non-invasive magneto-therapeutic approaches to bone healing have been successful in past clinical studies.
OBJECTIVE: To determine the effectiveness of low-amplitude, extremely
low frequency magnetic fields on patients with knee pain due to
osteoarthritis.
DESIGN: Placebo-controlled, randomized, double-blind clinical study.
SETTING: 4 outpatient clinics.
PARTICIPANTS: 176 patients were randomly assigned to 1 of 2 groups,
the placebo group (magnet off) or the active group (magnet on).
INTERVENTION: 6-minute exposure to each magnetic field signal using 8
exposure sessions for each treatment session, the number of treatment
sessions totalling 8 during a 2-week period, yielded patients being
exposed to uniform magnetic fields for 48 minutes per treatment session 8
times in 2 weeks. The magnetic fields used in this study were generated
by a resonator, which consists of two 18-inch diameter (46-cm diameter)
coils connected in series, in turn connected to a function generator
via an attenuator to obtain the specific amplitude and frequency. The
range of magnetic field amplitudes used was from 2.74 x 10(-7) to 3.4 x
10(-8) G, with corresponding frequencies of 7.7 to 0.976 Hz.
OUTCOME MEASURES: Each subject rated his or her pain level from 1
(minimal) to 10 (maximal) before and after each treatment and 2 weeks
after treatment. Subjects also recorded their pain intensity in a diary
while outside the treatment environment for 2 weeks after the last
treatment session (session 8) twice daily: upon awakening (within 15
minutes) and upon retiring (just before going to bed at night).
RESULTS: Reduction in pain after a treatment session was
significantly (P < .001) greater in the magnet-on group (46%)
compared to the magnet-off group (8%).
CONCLUSION: Low-amplitude, extremely low frequency magnetic fields
are safe and effective for treating patients with chronic knee pain due
to osteoarthritis.
Curr Med Res Opin. 2001;17(3):190-6.
Magnetic pulse treatment for knee osteoarthritis: a randomised, double-blind, placebo-controlled study.
Pipitone N, Scott DL.
Rheumatology Department, King’s College Hospital (Dulwich), London, UK.
Abstract
We assessed the efficacy and tolerability of low-frequency pulsed
electromagnetic fields (PEMF) therapy in patients with clinically
symptomatic knee osteoarthritis (OA) in a randomised,
placebo-controlled, double-blind study of six weeks’ duration. Patients
with radiographic evidence and symptoms of OA (incompletely relieved by
conventional treatments), according to the criteria of the American
College of Rheumatology, were recruited from a single tertiary referral
centre. 75 patients fulfilling the above criteria were randomised to
receive active PEMF treatment by unipolar magnetic devices (Medicur)
manufactured by Snowden Healthcare (Nottingham, UK) or placebo. Six
patients failed to attend after the screening and were excluded from
analysis. The primary outcome measure was reduction in overall pain
assessed on a four-point Likert scale ranging from nil to severe.
Secondary outcome measures included the WOMAC Osteoarthritis Index
(Likert scale) and the EuroQol (Euro-Quality of Life, EQ-5D). Baseline
assessments showed that the treatment groups were equally matched.
Although there were no significant differences between active and sham
treatment groups in respect of any outcome measure after treatment,
paired analysis of the follow-up observations on each patient showed
significant improvements in the actively treated group in the WOMAC
global score (p = 0.018), WOMAC pain score (p = 0.065), WOMAC disability
score (p = 0.019) and EuroQol score (p = 0.001) at study end compared
to baseline. In contrast, there were no improvements in any variable in
the placebo-treated group. There were no clinically relevant adverse
effects attributable to active treatment. These results suggest that the
Medicur unipolar magnetic devices are beneficial in reducing pain and
disability in patients with knee OA resistant to conventional treatment
in the absence of significant side-effects. Further studies using
different types of magnetic devices, treatment protocols and patient
populations are warranted to confirm the general efficacy of PEMF
therapy in OA and other conditions.
Altern Ther Health Med. 2001 Sep-Oct;7(5):54-64, 66-9.
Low-amplitude, extremely low frequency magnetic field for the treatment of osteoarthritic knees: a double-blind clinical study.
Jacobson JI, Gorman R, Yamanashi WS, Saxena BB, Clayton L.
Institute of Theoretical Physics and Advanced Studies for Biophysical
Research, Perspectivism Foundation, 2006 Mainsail Cir, Jupiter, FL
33477-1418, USA. drjjacobson@aol.com
CONTEXT: Noninvasive magnetotherapeutic approaches to bone healing have been successful in past clinical studies.
OBJECTIVE: To determine the effectiveness of low-amplitude, extremely
low frequency magnetic fields on patients with knee pain due to
osteoarthritis. DESIGN: Placebo-controlled, randomized, double-blind
clinical study.
SETTING: 4 outpatient clinics.
PARTICIPANTS: 176 patients were randomly assigned to 1 of 2 groups,
the placebo group (magnet off) or the active group (magnet on).
INTERVENTION: 6-minute exposure to each magnetic field signal using 8
exposure sessions for each treatment session, the number of treatment
sessions totaling 8 during a 2-week period, yielded patients being
exposed to uniform magnetic fields for 48 minutes per treatment session 8
times in 2 weeks. The magnetic fields used in this study were generated
by a Jacobson Resonator, which consists of two 18-inch diameter (46-cm
diameter) coils connected in series, in turn connected to a function
generator via an attenuator to obtain the specific amplitude and
frequency. The range of magnetic field amplitudes used was from 2.74 x
10(-7) to 3.4 x 10(-8) G, with corresponding frequencies of 7.7 to 0.976
Hz.
OUTCOME MEASURES: Each subject rated his or her pain level from 1
(minimal) to 10 (maximal) before and after each treatment and 2 weeks
after treatment. Subjects also recorded their pain intensity in a diary
while outside the treatment environment for 2 weeks after the last
treatment session (session 8) twice daily: upon awakening (within 15
minutes) and upon retiring (just before going to bed at night).
RESULTS: Reduction in pain after a treatment session was
significantly (P < .001) greater in the magnet-on group (46%)
compared to the magnet-off group (8%).
CONCLUSION: Low-amplitude, extremely low frequency magnetic fields
are safe and effective for treating patients with chronic knee pain due
to osteoarthritis.
Bratisl Lek Listy. 1999 Dec;100(12):678-81.
Personal experience in the use of magnetotherapy in diseases of the musculoskeletal system.
[Article in Slovak]
Sadlonova J, Korpas J.
Ist Dpt of Internal Medicine, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia. bll@fmed.uniba.sk
Therapeutic application of pulsatile electromagnetic field in
disorders of motility is recently becoming more frequent. Despite this
fact information about the effectiveness of this therapy in the
literature are rare. The aim of this study was therefore the treatment
of 576 patients who suffered from vertebral syndrome, gonarthritis and
coxarthritis. For application of pulsatile electromagnetic field MTU
500H Therapy System was used. Pulsatile electromagnetic field had a
frequency valve of 4.5 mT in all studied groups and magnetic induction
valve 12.5-18.75 mT in the 1st group. In the 2nd group the intensity was
5.8-7.3 mT and in the 3rd group it was 7.6-11.4 mT. The time of
inclination/declination in the 1st group was 20/60 ms, in the 2nd group
40/80 ms and in the 3rd group 40/90 ms. The electromagnetic field was
applied during 10 days. In the 1st-3rd day during 20 minutes and in the
4th-10th day during 30 minutes. The therapy was repeated in every
patient after 3 months with values of intensity higher by 50%. In the
time of pulsatile electro-magnetotherapy the patients were without
pharmacotherapy or other physiotherapy. The application of pulsatile
electromagnetic field is a very effective therapy of vertebral syndrome,
gonarthritis and coxarthritis. The results have shown that the therapy
was more effective in patients suffering from gonarthrosis, than in
patients with vertebral syndrome and least effective in patients with
coxarthosis. Owing to regression of oedema and pain relieve the motility
of patients improved. (Tab. 3, Ref. 19.)
opr Kurortol Fizioter Lech Fiz Kult. 1996 Mar-Apr;(2):26-8.
New methodological aspects in the use of cryotherapy, ultrasound,
magnetotherapy and therapeutic physical exercise in the rehabilitation
of gonarthrosis patients.
[Article in Russian]
Grigoreva VD, Fedorova NE
Gonarthritis complicated by synovitis was treated by cryo-ultrasound
or cryo-magnetotherapy in combination with therapeutic exercise. The
comparison of the response has shown that both complexes are highly
effective. In the absence of concomitant diseases and contraindications
to ultrasound it is better to use cryo-ultrasound and exercise,
otherwise cryo-magnetotherapy and exercise is preferential.
Ann Intern Med. 1994 Jul 15;121(2):133-40.
Published trials of nonmedicinal and noninvasive therapies for hip and knee osteoarthritis.
Puett DW, Griffin MR.
Vanderbilt University, Nashville, Tennessee.
Abstract
PURPOSE: To review the efficacy of nonmedicinal, noninvasive therapies in hip and knee osteoarthritis.
DATA SOURCES: Search of English-language literature from 1966 through
1993 using MEDLINE by cross-referencing “osteoarthritis” (therapy
subheadings) with “controlled trial,” “comparative study,” or
“trial(s).”
STUDY SELECTION: Fifteen controlled trials of diathermy (deep heat),
exercise, acupuncture, transcutaneous electrical nerve stimulation,
topically applied capsaicin, low-energy laser, and pulsed
electromagnetic fields were found. No experimental studies of
superficial heat and cold, orthotic devices, vibration, or weight loss
were identified.
RESULTS: Exercise reduces pain and improves function in patients with
osteoarthritis of the knee. No support exists in the literature for
pre-exercise ultrasound treatment. Single, well-designed studies suggest
that topically applied capsaicin and laser treatment reduce pain
associated with knee osteoarthritis. Data on the other three therapies
were sparse (transcutaneous electrical nerve stimulation, pulsed
electromagnetic fields) or inconsistent (acupuncture).
CONCLUSIONS: More data are needed to determine the optimal exercise
regimen for treating knee osteoarthritis and to evaluate the role of
topical capsaicin, laser therapy, acupuncture, transcutaneous electrical
nerve stimulation, and pulsed electromagnetic fields. No data
specifically address the role of any of these therapies in hip
osteoarthritis.
J Bone Joint Surg Am. 1983 Apr;65(4):480-5.
The use of pulsing electromagnetic fields to achieve arthrodesis of
the knee following failed total knee arthroplasty. A preliminary report.
Bigliani LU, Rosenwasser MP, Caulo N, Schink MM, Bassett CA.
Abstract
Treatment with pulsing electromagnetic fields was used as an adjunct
in twenty patients who had had a knee arthrodesis after failure of a
total joint arthroplasty. Eighteen had had an infected arthroplasty;
one, mechanical loosening; and one, recurrent dislocation. Arthrodesis
had been attempted twenty-five times in these twenty patients prior to
application of the coils. These procedures included the use of
twenty-two external fixation frames, one compression plate, one
intramedullary rod, and one cylinder cast. Two groups of patients were
identified: those with non-union and those with delayed union. Fourteen
patients began treatment six months or more after arthrodesis and were
considered to have a non-union. The other six patients started treatment
less than six months after attempted arthrodesis because there was no
evidence of progression toward union. They were considered to have
delayed union. In seventeen (85 per cent) of the twenty patients a
clinically solid arthrodesis with roentgenographic evidence of
bone-bridging was achieved. The average time to union after coil therapy
was started was 5.8 months, with a range of three to twelve months. The
patients who started coil treatment earlier after arthrodesis showed a
tendency to heal faster. The three patients who had failures were the
only ones who did not adhere to the protocol, and all three were in the
non-union group. All patients with a solid arthrodesis were free of pain
and able to walk at the time of follow-up, nine to thirty-one months
after the completion of treatment. The use of pulsing electromagnetic
fields appears to be a valuable non-invasive adjunct when performing
arthrodesis of the knee after failed total joint arthroplasty. |