ULTRASOUND THERAPY IN MUSCULOSKELETAL DISORDERS - A METAANALYSIS

We have reviewed 293 papers published since 1950 to assess the evidenc e of effect of ultrasound in the treatment of musculoskeletal disorder s. Twenty-two clinical papers describing trials comparing ultrasound t reatment with sham-ultrasound treated, non-ultrasound treatment and un treated groups were found. These papers were evaluated with respect to a list of criteria which should be met in this type of trial. They we re generally found lacking with respect to description of drop-outs, r andomisation methods, ultrasound apparatus, sham-ultrasound apparatus, control of apparatus, mode of delivery, size of sound-head, treated a rea and follow-up time. In 16 of these trials, ultrasound treatments w ere compared with sham-ultrasound and in 13 cases data were presented in a way that made pooling possible. Two standardized effect sizes (d( d/r) and d(d/s)) were applied to the results to enable evaluation of t he effect of ultrasound treatment on pain. None of the methods (d(d/r) = 0.64%, confidence limits -6.7 to 7.5%; and d(d/s) = 0.24, confidenc e limits -0.01 to 0.49) gave evidence that pain relief could be achiev ed by ultrasound treatment. Hence we found no reason to analyze the ot her papers where ultrasound treatment was compared with another treatm ent or an untreated control group. We found a significant influence of degree of blinding using the d/s for the analysis (t test, P = 0.009) , while when the d/r was used, only a trend was found (P = 0.10). An a nalysis of the effect of proper randomisation on the result was not po ssible because of inadequate description of the methods used. We concl ude that the use of ultrasound in treatment of musculoskeletal disorde rs is based on empirical experience, but is lacking firm evidence from well-designed controlled studies. One question remaining is whether u ltrasound treatment can augment an effect of exercise therapy with res pect to musculoskeletal disorders.