Therapeutic ultrasound for knee osteoarthritis: A systematic review and meta-analysis with grade quality assessment

Dantas LO, Osani MC, Bannuru RR · Brazilian Journal of Physical Therapy

Against sham, pain improved by a standardised mean difference of -0.33 (95% CI -0.60 to -0.07), which the authors convert to 9.6% on a 0-100 visual analogue scale (95% CI 2% to 17.4%), and self-reported function by -0.33 (95% CI -0.65 to -0.01), or 12.8% (95% CI 0.4% to 25.2%). Overall quality of evidence: very low. The one trial that measured cartilage found no difference: central medial femoral cartilage volume at eight weeks, 11 against 12 participants, SMD 0.11 lower (95% CI 0.93 lower to 0.71 higher), graded very low. Quality of life was likewise unmoved. No treatment-related adverse event was reported in any trial.

Population

Adults with symptomatic knee osteoarthritis in 5 randomised trials published 2009-2017, 4 of them sham-controlled; trials combining ultrasound with exercise or any other therapy were excluded, which is what left so few

Intervention

Therapeutic ultrasound alone, continuous in three trials, pulsed in one, both arms in one, for two to eight weeks

Comparator

Sham ultrasound in the four primary trials; no treatment in the fifth

Limitations

Author-reported: every trial randomised fewer than 100 people, so small-study effects are likely; follow-up ran 2 to 8 weeks; data extraction was done by a single reviewer; PEDro, SPORTDiscus and CINAHL were not searched. The authors' own conclusion is that the evidence is not adequate in size or quality to make a clinical recommendation. Self-reported function improved where performance-based walking measures largely did not. Funded by the Sao Paulo Research Foundation (FAPESP 2018/23705-3) and the NIH National Center for Complementary and Integrative Health (K23AT009374); the authors declare no conflicts of interest.