There appears to be clear evidence for the recommendation that PEMF does not significantly reduce the pain of knee osteoarthritis. In a randomized, placebo-controlled study, Ay and Evcik examined the effects of PEMF on pain relief and functional capacity of patients with knee osteoarthritis.
A total of 55 patients were included. These investigators observed statistically significant improvement in some of the subgroups of Lequesne index e. Applying between-group analysis, the authors were unable to demonstrate a beneficial symptomatic effect of PEMF in the treatment of knee osteoarthritis in all patients. They stated that further studies using different types of magnetic devices, treatment protocols and patient populations are warranted to confirm the general efficacy of PEMF therapy in knee osteoarthritis and other conditions. Aktas et al noted that subacromial impingement syndrome SIS is a frequent cause of shoulder pain.
In a double-blinded, randomized, and controlled study, these rsearchers examined if PEMF provided additional benefit when used with other conservative treatment modalities in acute phase rehabilitation program of SIS. A total of 46 patients with unilateral shoulder pain who had been diagnosed as having SIS were included in this trial. The cases were randomly separated into two groups. All cases received a treatment program for 3 weeks consisting of Codman's pendulum exercises and subsequent cold pack gel application on shoulders with pain 5 times a day, restriction of daily activities that require the hands to be used over the head, and meloxicam tablet 15 mg daily.
Shoulder pain during rest and activity and which causes disturbance of sleep was evaluated using a visual analog scale VAS , and total Constant score investigated shoulder function. Daily living activities were evaluated by shoulder disability questionnaire.
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Results were assessed before and after treatment. The authors concluded that there is no convincing evidence that PEMF therapy is of additional benefit in acute phase rehabilitation program of SIS. In a randomized, controlled, prospective multi-center clinical trial, Foley and associates examined the safety and effectiveness of PEMF stimulation as an adjunct to arthrodesis following anterior cervical discectomy and fusion ACDF in patients with potential risk factors for non-union.
A total of patients with radiographical evidence computed tomography-myelogram [CT-myelo] or magnetic resonance imaging [MRI] of a compressed cervical nerve root and symptomatic radiculopathy appropriate to the compressed root that had failed to respond to non-operative management were enrolled in the study. Allograft bone and an anterior cervical plate were used in all cases. Two orthopedic surgeons not otherwise affiliated with the study and blinded to treatment group evaluated the radiographs, as did a blinded radiologist.
Adverse events were reported by all patients throughout the study to determine device safety. Patients were randomly assigned to one of two groups:. Post-operative care was otherwise identical. Follow-up was carried out at 1, 2, 3, 6, and 12 months post-operatively. The PEMF and control groups were comparable with regard to age, gender, race, past medical history, smoking status, and litigation status.
Both groups were also comparable in terms of baseline diagnosis herniated disc, spondylosis, or both and number of levels operated 1, 2, 3, or 4. At 6 months post-operatively, the PEMF group had a significantly higher fusion rate than the control group At 12 months after surgery, the stimulated group had a fusion rate of No significant differences were found in the incidence of adverse events in the groups.
This was the first randomized, controlled trial that analyzed the effects of PEMF stimulation on cervical spine fusion. While PEMF stimulation significantly improved the fusion rate at 6 months post-operatively in patients undergoing ACDF with an allograft and an anterior cervical plate, however, the fusion rate for PEMF patients was not significantly different from that of the control group at 12 months post-operatively. Biering-Sorensen et al reviewed the literature on non-pharmacological prevention and treatment of osteoporosis following spinal cord injury SCI. All identified papers were read by title, abstract and full-length article when relevant.
Hand search of the articles' sources identified additional papers. For included studies, the level of evidence was determined. No studies conclusively showed an effective intervention. However, there are few randomized controlled trials RCTs , and those that exist assess interventions and outcome measures that could be improved.
Electromagnetic Fields Associated With the M‐Component Mode of Charge Transfer
Five studies on weight-bearing early post-injury are conflicting, but standing or walking may help retain bone mineral. In the chronic phase, there was no effect of weight-bearing 12 studies.
One study found that an early commencement of sports after SCI improved bone mineral, and the longer the period of athletic career, the higher the leg bone mineral. Chronic-phase ES studies vary 14 studies, including mixed periods after injury , but improvement is seen with longer period of training, or higher frequency or stimulus intensity. Improvements correspond to trabecular bone in the distal femur or proximal tibia.
Impact vibration and pulsed electromagnetic fields may have some positive effects, whereas pulsed ultrasound does not. Six studies on the influence of spasticity show inconsistent results. The authors concluded that bone mineral should be measured around the knee; the length and intensity of the treatment should be sufficiently long and high, respectively, and should commence early after SCI. If bone mineral is to remain, the stimulation has to be possibly continued for long-term.
In addition, these investigators stated that RCTs are necessary. In a randomized, double-blind, placebo-controlled, parallel study, Weintraub et al examined if repetitive and cumulative exposure to low-frequency PEMF targeting painful feet can reduce neuropathic pain NP , influence sleep in symptomatic diabetic peripheral neuropathy DPN , and influence nerve regeneration. Nerve conduction testing was performed serially. A subset of subjects underwent serial 3-mm punch skin biopsies from 3 standard lower limb sites for epidermal nerve fiber density ENFD quantification.
Increases in distal thigh ENFD were significantly correlated with decreases in pain scores. However neurobiological effects on ENFD, PGIC and reduced itching scores suggest future studies are indicated with higher dosimetry to G , longer duration of exposure, and larger biopsy cohort.
Sutbeyaz and colleagues evaluated the clinical effectiveness of low-frequency PEMF therapy for women with fibromyalgia FM. Pieber et al reviewed different types of electrotherapy for the treatment of painful diabetic peripheral neuropathy. Articles in English and German were selected. The efficacy of different types of electrotherapy for painful diabetic peripheral neuropathy has been evaluated in 15 studies; the effects of transcutaneous electrical nerve stimulation are consistent.
Only small studies were found concerning other types of electrotherapy, such as pulsed-dose electrical stimulation, high-frequency external muscle stimulation or high-tone external muscle stimulation. The conclusions drawn in these articles were diverse. Shortcomings and problems, including a poor study design, were observed in some.
The authors concluded that further randomized, double-blind, placebo-controlled studies comprising larger sample sizes, a longer duration of treatment, and longer follow-up assessments are needed. Management was otherwise unaltered. Main analyses were by intention-to-treat. Compliance was moderate, with 6. No between-group differences were found with regard to surgical intervention for any reason, radiographic union, or functional measures.
A total of 12 patients with mandibular fractures were selected for the present study. Each patient was treated by closed reduction using maxillo-mandibular fixation MMF and was assigned into 1 of 2 equal groups. For group B control group , the MMF was removed at 4 weeks post-operatively. The effectiveness of the 2 treatment modalities was evaluated clinically and radiographically using computerized densitometry. The data were statistically analyzed. After releasing the MMF, a bi-manual mobility test of the fractured segments showed stability of the segments in all cases. An insignificant difference was found between the mean bone density values of the 2 groups at all study intervals.
In contrast, the percentage of changes in bone density of the 2 groups revealed that group A had insignificant decreases at the 15th post-operative day and a significant increase 30 days post-operatively compared with group B. The authors concluded that from the present limited series of patients, PEMF stimulation might have a beneficial effect on the healing of mandibular fractures treated with closed reduction. However, additional research, using RCTs, should be conducted to ascertain its effectiveness compared with other treatment modalities.
In a Cochrane review, Griffin et al evaluated the effects of electromagnetic stimulation for treating delayed union or non-union of long bone fractures in adults. Randomized controlled trials evaluating electromagnetic field stimulation for the treatment of delayed union or non-union of long bones in adults were selected. Two authors independently selected studies and performed data extraction and risk of bias assessment.
Electromagnetic fields (EMF)
Treatment effects were assessed using risk ratios and, where appropriate, data were pooled using a random-effects model. Participants with delayed union and non-union of the long bones were included, but most data related to non-union of the tibia. Although all studies were blinded randomized placebo-controlled trials, each study had limitations.
The primary measure of the clinical effectiveness of electromagnetic field stimulation was the proportion of participants whose fractures had united at a fixed time point.
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The overall pooled effect size was small and not statistically significant risk ratio 1. A sensitivity analysis conducted to determine the effect of multiple follow-up time-points on the heterogeneity among the studies showed that the effect size remained non-significant at 24 weeks risk ratio 1.
No study reported functional outcome measures. The authors concluded that although the available evidence suggests that electromagnetic field stimulation may offer some benefit in the treatment of delayed union and non-union of long bone fractures, it is inconclusive and insufficient to inform current practice.
They stated that more definitive conclusions on treatment effect await further well-conducted RCTs. Schmidt-Rohlfing et al performed a systematic review and meta-analysis on the potential effects of electromagnetic fields and high-frequency electric fields on bony healing. Randomized clinical trials were identified and analyzed. Those studies with the primary endpoint "rate of bony healing" were combined in a meta-analysis which was performed with the "random effects" model.
The majority of these studies used PEMF. When performing a subgroup analysis a statistically significant result could not be confirmed by the studies with a higher methodological quality.
In view of the heterogeneous physical parameters with different frequencies, time course, flux densities and in view of the methodological deficits, a general conclusion seems difficult. In a randomized, double-blind, placebo-controlled, multi-center trial, Hannemann et al examined the effectiveness of PEMF therapy to stimulate bone growth in patients with acute scaphoid fractures.
The clinical and radiological outcomes were assessed at 4, 6, 9, 12, 24 and 52 weeks. A log-rank analysis showed that neither time to clinical and radiological union nor the functional outcome differed significantly between the groups.
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The authors concluded that stimulation of bone growth by PEMF has no additional value in the conservative treatment of acute scaphoid fractures. In a case-series study, Marcheggiani Muccioli et al examined if PEMF treatment might improve symptoms in the early stage of spontaneous osteonecrosis of the knee. A total of 28 patients 19 males and 9 females, aged Treatment failure was defined as patients undergoing knee arthroplasty.
Pain significantly reduced at 6 months from Knee society score significantly increased in first 6 months from EQ-5D improved significantly throughout the 24 months 0.