Electrotherapy for neck disorders
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BACKGROUND: Neck disorders are common, disabling and costly. The effectiveness of electrotherapy as a physiotherapy option has remained unclear. OBJECTIVES: To assess whether electrotherapy, either alone or in combination with other treatments, relieves pain, or improves function/disability, patient satisfaction, and global perceived effect in adults with mechanical neck disorders (MND). SEARCH STRATEGY: Computer-assisted searches of bibliographic databases: CENTRAL, MEDLINE, EMBASE, MANTIS, CINAHL, and ICL, without language restrictions, from their beginning to March 2003. SELECTION CRITERIA: Randomised or controlled clinical trials with quasi-randomisation (alternate allocation, case record numbers, dates of birth, etc.), in any language, investigating the effects of electrotherapy as a treatment for MND. DATA COLLECTION AND ANALYSIS: At least two authors independently conducted citation identification, study selection, data abstraction, and methodological quality assessment. Using a random-effects model, relative risk, and standardized mean differences were calculated. The reasonableness of combining studies was assessed on clinical and statistical grounds. Due to heterogeneity, pooled effect measures were not calculated. MAIN RESULTS: Fourteen comparisons (525 people with MND), in 11 publications, were included in this review. The analysis was limited by underpowered low quality trials, paucity of literature, and heterogeneity of treatment subtypes. The results for the electrotherapy subtypes are: Limited evidence of benefit: low or high frequency pulsed electromagnetic field (PEMF) compared to placebo, provides immediate post treatment pain relief only for chronic MND, acute whiplash (WAD) Unclear or conflicting evidence: direct and modulated Galvanic current compared to other treatments for pain in acute, subacute, chronic occipital headache iontophoresis compared to other treatments for pain, RTW, and self-assessment of overall outcome in acute, subacute WAD TENS compared to placebo for pain in acute WAD, chronic MND PEMF compared to placebo for medium or long term effect on pain, patient assessment of improvement, ADL in acute WAD, chronic MND Limited evidence of no benefit: diadynamic current compared to placebo for reduction of trigger point tenderness in chronic MND with radicular findings, cervicogenic headache permanent magnets compared to a placebo for pain in chronic MND electric muscle stimulation compared to a sham control for pain in chronic MND. AUTHORS' CONCLUSIONS: We can not make any definitive statements on electrotherapy for MND. The current evidence on Galvanic current (direct or pulsed), iontophoresis, TENS, EMS, PEMF and permanent magnets is either lacking, limited, or conflicting. Possible new trials on these interventions should have larger patient samples and include more precise standardization and description of all treatment characteristics.