Effects of deep heating to treat osteoarthritis pain: systematic review

Jorge, Matheus Santos Gomes; Zanin, Caroline; Knob, Bruna; Wibelinger, Lia Mara

doi:10.5935/1806-0013.20170016

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REVIEW ARTICLES • Rev. dor 18 (1) • Jan-Mar 2017 • https://doi.org/10.5935/1806-0013.20170016 linkcopy

Effects of deep heating to treat osteoarthritis pain: systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

BACKGROUND AND OBJECTIVES: Osteoarthritis is an inflammatory and degenerative joint disease, causing pain, musculoskeletal disorders and impact on functionality, daily life activities and quality of life. The action of physical agents by means of deep heating seems to be an alternative to treat such disease. This study aimed at verifying the effects of deep heating on osteoarthritis patients.

CONTENTS: A systematic review was carried out in Medline, Scielo and LILACS databases as from keywords "Osteoarthritis", "Induced Hyperthermia", "Physiotherapy" and "Ultrasound", and other keywords such as "Deep heat", "Microwaves" and Short-waves", in Portuguese, English and Spanish, in the period from January 2005 to January 2016, and 986 articles were found. Initially, 16 potentially relevant articles were selected for the study and, after a judicious qualitative analysis, nine complete articles meeting inclusion criteria were selected.

CONCLUSION: Physical deep heating physical agents (ultrasound, short-waves diathermy and microwaves) were beneficial to manage pain and other variables in individuals with osteoarthritis in different levels of severity, especially in the long term. However, these effects are better observed when applied simultaneously with kinesiotherapy.

Keywords:
Induced hyperthermia; Osteoarthritis; Pain; Physiotherapy; Ultrasound

Studies identified by electronic search in Medline (n=873), Scielo (n=98) and LILACS (n=15) databases
Screening	970 were excluded by title and abstract	Other physiotherapeutic approaches: 396
		Outside of the subject: 364
		Non-randomized studies: 64
		Duplication of themes: 52
		Surgical approach: 39
		Pharmacological approach: 34
		Unfinished studies: 21
Eligibility	16 complete evaluated articles	7 have not met inclusion criteria
		3 had no outcome variables
		2 were not available in full and for free
		1 was unfinished
		1 was a systematic review
Inclusion	9 articles were included in the qualitative synthesis

Authors	Number	Age (years)	Gender	Affection	Osteoarthritis level
Akyol et al.¹⁰	40	±58.2	40 females 0 males	Bilateral	I, II or III
Rabini et al.¹³	54	±65.15	45 females	Uni or bilateral	II or III
			9 males
Jan et al.¹⁴	30	±65.7	24 females 6 males	Uni or bilateral	I, II or III
Silva, Imoto & Croci¹⁵	25	±67.56	19 females 6 males	Unilateral	I
Fukuda et al.¹⁶	121	±60	121 females 0 males	Not specified	II or III
Carlos, Belli e Alfredo¹⁷	30	±63.33	21 females 9 males	Uni or bilateral	II, III or IV
Atamaz et al.¹⁸	203	±61.48	167 females	Uni or bilateral	II or III
			36 males
Mascarin et al.¹⁹	40	±62.4	40 females 0 males	Bilateral	Not specified
Chen et al.²⁰	120	±63.0	102 females	Bilateral	III
			18 males

Authors	Evaluation tools and intervention protocol	Outcomes
Akyol et al.¹⁰	Evaluation: WOMAC, VAS, isokinetic dynamometry, SF-36, TC6, Beck	SWD has no additional significant effect on pain and other variables (functionality, stiffness, depression, gait velocity, muscle strength and quality of life).
	inventory.
	Intervention:
	G1 (n=20): kinesiotherapy (muscle strengthening on isokinetic dynamometer) +
	SWD (frequency 27,12 MHz, intensity according to patients’ sensitivity, time of
	20 minutes);
	G2 (n=20): kinesiotherapy (same protocol as G1);
	IT: 12 sessions, 3x/week, 4 weeks.
Rabini et al.¹³	Evaluation: WOMAC, BMRC, VAS.	MW has decreased pain and improved other variables (muscle strength and physical function) with long term benefits.
	Intervention:
	G1 (n=27): MW (potency of 40W, temperature of 38°C, time of 30 minutes).
	G2 (n=27): hot compresses (temperature of 38°C, time of 30 minutes).
	IT: 12 sessions, 3x/week, to 4 weeks.
Jan et al.¹⁴	Evaluation: ultrasound, VAS.	SWD has significantly decreased pain and synovial thickness.
	Intervention:
	G1 (n=11): SWD (intensity tolerated by patient, time of 20 minutes);
	G2 (n=10): SWD (same protocol as G1) + drugs (non-steroid anti-inflammatory
	drugs);
	G3 (n=9): control.
	IT: 30 sessions, 3x to 5x/ week, up to 8 weeks.
Silva, Imoto & Croci¹⁵	Evaluation: sphygmomanometer, VAS, goniometry, Lequesne index.	Most adequate protocol for improving pain was that of G2. Both protocols were effective in improving functionality, joint movement amplitude and flexibility, while only G3 has improved muscle strength.
	Intervention:
	G1(n=9): SWD (20 minutes, without specifying parameters) + kinesiotherapy (wi-
	thout specification);
	G2(n=6): criotherapy (20 minutes) + kinesiotherapy (without specification);
	G3(n=9): kinesiotherapy (without specification);
	IT: 10 sessions, 2x/week.
Fukuda et al.¹⁶	Evaluation: KOOS questionnaire;	Pulsed SWD is an effective method to decrease pain and improve other variables (functionality and quality of life) in the short term.
	Intervention:
	G1 (n=35): control.
	G2 (n=23): placebo (19 minutes).
	G3 (n=32): pulsed low dose SWD (power 14,5W, time 19 minutes; total energy
	17 kJ);
	G4 (n=31): pulsed high dose SWD (power 14,5W, time 38 minutes; total energy
	33kJ).
	IT: 9 sessions, 3x/week.
Carlos, Belli & Alfredo¹⁷	Evaluation: WOMAC, Lequesne Index, VAS, goniometry, portable dinamometry	CUS associated to kinesiotherapy was the most effective protocol to decrease pain and improve other variables (joint mobility, functionality and quality of life).
	and TGUG.
	Intervention:
	G1(n=10): CUS (intensity 1.5 W/cm2, continuous mode – 100%) + kinesiotherapy
	(heating, muscle strengthening, time 45 minutes);
	G2(n=10): PUS (intensity 2.5 W/cm2, pulsed mode 20% – pulse repetition fre-
	quency 100 Hz) + kinesiotherapy (same protocol as G1);
	G3(n=10): kinesiotherapy (same protocol as G1).
	IT: G1 and G2: 24 sessions (first 12; use of US and for other exercises).
	IT G3: 24 sessions (kinesiotherapy alone).
	Evaluation: VAS, WOMAC, TC15, goniometry, drug ingestion.	Groups using physical agents have decreased pain and drug ingestion in a more significant way, although all groups have shown improvements.
	Intervention:
Atamaz et al.¹⁸	G1 (n=37): TENS sham and kinesiotherapy*;
	G2 (n=37): TENS (frequency 80Hz, intensity 10 to 30 mA, time 20 minutes) +
	kinesiotherapy*;
	G3 (n=35): CI sham + kinesiotherapy*;
	G4 (n=31): CI (modulation frequency in amplitude of 100 Hz, time 20 minutes) +
	kinesiotherapy*;
	G5 (n=32): US sham + kinesiotherapy*;
	G6 (n=31): US (frequency of 27.12MHz and intensity of 3.2 W/cm², time 20 minu-
	tes) + kinesiotherapy*;
	*kinesiotherapeutic program used for all groups: warm up, muscle elongation and
	muscle strengthening.
	IT of physical agents: 15 sessions, 5x/week.
	IT of kinesiotherapy exercises: 09 sessions, 3x/week.
Mascarin et al.¹⁹	Evaluation: WOMAC, VAS, goniometry, TC6.	Both groups were effective in decreasing pain and improving WOMAC variables.
	Intervention:
	G1 (n=16): kinesiotherapy (muscle elongation and strengthening, time 20 minu-	However, just G2 and G3 have improved travelled distance in TC6.
	tes);
	G2 (n=12): TENS (frequency of 100 Hz, pulse width 50 mS, intensity according
	to individual sensitivity, mode 50% frequency, quadratic, two-phase symmetric
	pulse, during 20 minutes) + kinesiotherapy (same protocol as G1);
	G3 (n=12): US (frequency of 01 MHz and intensity at 0.8 W/cm², time 25 minutes)
	+ kinesiotherapy (same protocol as G1);
	IT: 24 sessions, 2x/week.
Chen et al.²⁰	Evaluation: goniometry, VAS, Lequesne Index, isokinetic dinamometry.	Shock waves therapy was better than USP to decrease pain and other variables (joint movement amplitude, functionality, muscle strength).
	Intervention:
	G1 (n=30): isokinetic muscle strengthening (muscle elongation, application of
	warm compresses on affected site, heating, muscle strengthening of knee ex-
	tensors and flexors).
	G2 (n=30): PUS (frequency of 1 MHz, intensity of 2.5 W/cm2, pulse of 25%, time
	10 minutes).
	G3 (n=30): shock waves (density 0.03-0.4 mJ/mm2, frequency 1-8 Hz and pres-
	sure range of 11-82 MPa).
	G4 (n=30): control.
	IT: 24 sessions (3x/week), except G3 (18 sessions).

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[TFN1] BMRC = British Medical Research Council; IC = interferential current; SWD = short waves diathermy; VAS = visual analog scale; G1 = group 1; G2 = group 2; G3 = group 3; G4 = group 4; G5 = group 5; G6 = group 6; MW = microwaves; SF-36 = Short Form Health Survey-36; TC6 = 6 minutes walking test; TC15m = 15 meters walking test in shorter time; TENS = transcutaneous electrical nerve stimulation; TGUG = timed get up and go; IT = intervention time; CUS = continuous ultrasound; PUS = pulsed ultrasound; WOMAC = Western Ontario and McMaster Universities Osteoarthritis Index.

[TFN2] ^*
= Kinesiotherapeutic program consisting of heating, muscle stretching and muscle strengthening.