Systematic review of the use of physical agents for soft tissue injuries in the lower limb

Study Type: Systematic review
OE Level of Evidence: 2
Journal Level of Evidence: N/A
23 randomized controlled trials (RCTs) were included in this systematic review to determine the efficacy and safety of physical agents for patients with plantar fasciitis (n=13 RCTs), ankle sprains (n=4 RCTs), Achilles tendinopathy (n=3 RCTs), and patellofemoral pain syndrome (n=3 RCTs). All included trials were reported to contain low risks of bias. Qualitative analysis indicated Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-Industry funded
Sponsor: Ontario Ministry of Finance and the Financial Services Commission of Ontario
Conflicts: Other
Why was this study needed now?
Physical agents, distinguished as rehabilitation with devices that can be utilized without active patient participation, are commonly implemented in the treatment of lower-limb soft tissue injuries. Despite the popularity of such procedures, including electrotherapy or ultrasound, evidence reporting on their efficacy and safety is still inconsistent. Therefore, an updated qualitative analysis of available evidence was necessary.
What was the principal research question?
Are the use of physical agents effective and safe for treating soft tissue injuries of the lower limb?
Data Source: MEDLINE, Ovid MEDLINE In-Process & Other Non-Indexed Citations, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, and CINAHL Plus databases were searched for relevant studies from January 1, 1990 to January 26, 2015.
Index Terms: A detailed list of search terms can be found in the appendix of the article.
Study Selection: Eligibility criteria consisted of low risk of bias randomized controlled trials, cohort studies, or case-control studies of the English language containing at least 30 patients per treatment arm; patients with grade I or II sprains/strains, tendinopathy and non-specific lower-limb pain without major pathology; physical agent interventions compared to no intervention, an alternative intervention, or placebo treatment; and studies that contained at least one of the following outcomes: patient-reported recovery, functionality; pain intensity; health-related quality of life, or adverse events. Physical agents were classified as either physicochemical (electrochemical or thermal treatment effects such as cryotherapy) or structural (nonfunctional devices such as cast immobilization or functional devices such as foot orthoses). A total of 23 RCTs were eligible for inclusion.
Data Extraction: One author independently extracted data from the included articles and another author independently reviewed the extracted data. All disagreements were resolved through discussion.
Data Synthesis: Pooled quantitative analysis of data was not performed; results from the included trials were analyzed qualitatively. Significance between groups was measured using minimal clinically important differences (MCIDs). To achieve the MCID, between-group differences must be 2/10 on the numeric rating scale, 7.7% for the physical component summary score on the Short Form-36 health survey, 12/100 on the Victorian Institute of Sport Assessment-Achilles questionnaire, 9/100mm for the visual analogue scale (VAS) average pain score, 19/100mm on a VAS for plantar fasciitis, 14/100 for pain and 7/100 for function on the Foot Health Status questionnaire, 12/100 for pain and 7/100 for total function on the Foot Function Index, and 8/100 for function on the foot and ankle computerized adaptive test.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.