| Author, Year, Followup,a Pain Duration, Study Quality | Intervention | Population | Function and Pain Outcomes | Other Outcomes |
|---|---|---|---|---|
Al Rashoud, 2014150 1.5 and 6 months Duration of pain: 11 years Fair | A. Low-level laser therapy (n=26): continuous laser (30 mW, 830 nm wavelength) applied to 5 acupuncture points over approximately of 10 sessions B. Placebo laser (n=23): placebo laser applied to 5 acupuncture points over approximately 10 sessions | A vs. B Age: 52 vs. 56 years Female: 62% vs. 65% Baseline Saudi Knee Function Scale (SKFS) (0-112), median: 61.0 vs. 60.0 Baseline pain on movement VAS (0-10): 6.4 vs. 5.9 | A vs. B 1.5 months Pain on movement VAS: 3.0 vs. 4.2b SKFS, median: 31 vs. 40, median difference −10 (95% CI −23 to −4) p=0.054 6 months Pain on movement VAS: 3.4 vs. 5.2b SKFS, median: 31 vs. 51, median difference −21 (95% CI −34 to −7) p=0.006 | NR |
Battisti, 2004151 1 month Duration of pain: 11 years Poor | A. Therapeutic Application of Musically Modulated Electromagnetic Field (TAMMEF) (n=30): The anatomical region treated is placed between opposing faces of low frequency electromagnets (3x4 cm). The current from amplifier B feeds a loud speaker that plays music. The music modifies parameters (frequency, intensity, waveform) of the electromagnetic field in time, randomly varying within respective ranges. 15 consecutive daily sessions, 30 minutes each B. Extremely Low Frequency (ELF) (n=30): Similar treatment as Intervention A except the electromagnetic field is stabilized at a frequency of 100Hz in a sinusoidal waveform. 15 consecutive daily sessions, 30 minutes each C. Simulated (Sham) Frequency Field (n=30): Functionally similar operation to the other groups except a simulated (noneffective) field is used, but the patients remain blinded to its effectiveness. 15 consecutive daily sessions, 30 minutes each | A + B + C Age: 58.9 (7.4) Female: 70% Race: NR Mean Duration of Chronicity: 11 (3.1) A vs. B vs. C Baseline Mean Lequesne Function Score (0-10)c: 3.65 vs. 4.28 vs. 3.48 Baseline Mean Lequesne Pain Score (0-10)c: 6.88 vs. 6.28 vs. 6.15 | A vs. C 1 month Mean Lequesne Functionality: 6.5 vs. 3.8 Mean Lequesne Pain Score: 1.4 vs. 6.9 B vs. C 1 month Mean Lequesne Functionality: 7.1 vs. 3.8 Mean Lequesne Pain Score: 1.4 vs. 6.9 | NR |
Brouwer, 2006152 6 and 12 months Duration of pain: 6.7 vs. 4.9 years Poor | A. Brace (n=60): Device: Oasys brace, Innovation Sports, Irvine, CA, USA, brace allowed medial or lateral unloading; patients also received usual care B. Usual Care (n=57): patient education (adaptation of activities and/or weight loss), and (if needed) physical therapy and analgesic | A vs. B Agef: 59.2 Female: 48% vs. 51% Race: NR Baseline HSS Knee Function Score (0-100): 64.9 vs. 69.0 Baseline VAS pain severity (0-10): 6.6 vs. 5.5 | A vs. B 6 months HSS Knee Function: difference 3.2 (95% CI −0.6 to 7.0) VAS Pain Severity: difference −0.6 (95% CI −1.5 to 0.3) 12 months | A vs. B 6 months EQ-5D: difference 0.01 (95% CI −0.08 to 0.10) 12 months |
Cakir, 2014153 6 months Duration of pain: Mean 4.0 to 5.1 years Fair | A. Continuous ultrasound (n=20): 5 times a week for 2 weeks B. Pulsed ultrasound (n=20): 5 times a week for 2 weeks C. Sham (n=20): 5 times a week for 2 weeks All patients performed home exercise program 3 days a week for 8 weeks | A vs. B vs. C Age: 57 vs. 58 vs. 57 years Female: 70% vs. 80% vs. 85% Baseline WOMAC physical mean function (0-68): 55.7 vs. 52.4 vs. 52.5 Baseline WOMAC pain (0-20):15.9 vs. 14.5 vs. 14.9 Baseline WOMAC stiffness (0-8): NR Baseline pain at rest VAS (0-10): 57.9 vs. 55.7 vs. 53.6 Baseline pain on movement VAS (0-10): 75.5 vs. 73.0 vs. 72.2 Baseline disease severity VAS (0-10): 73.9 vs. 67.9 vs. 68.4 | A vs. C 6 months WOMAC physical function: 32.6 vs. 35.5, difference −2.9 (95% CI −9.2 to 3.4) WOMAC pain: 9.5 vs. 11.1, difference −1.6 (95% CI −3.3 to 0.1) Pain at rest VAS: 21.4 vs. 22.3, difference 1.2 (95% CI −9.1 to 11.5) Pain on movement VAS: 38.7 vs. 38.1, difference 0.6 (95% CI −13.7 to 14.9) Disease severity VAS: 30.0 vs. 29.5, difference 0.5 (95% CI −6.7 to 7.7) B vs. C 6 months WOMAC physical function: 37.1 vs. 35.5, difference 1.6 (95% CI −3.0 to 6.2) WOMAC pain: 11.3 vs. 11.1, difference 0.2 (95% CI −1.3 to 1.7) Pain at rest VAS: 20.2 vs. 22.3, difference −2.1 (95% CI −11.2 to 7.0) Pain on movement VAS: 37.5 vs. 38.1, difference −0.6 (95% CI −17.0 to 15.8) Disease severity VAS: 32.5 vs. 29.5, difference 3.0 (95% CI −4.0 to 10.0) | NR |
Fary, 2011154 6.5 months Duration of pain: 12 years Good | A. Pulsed electrical stimulation (TENS) (n=34): pulsed electrical stimulator worn 7 hours a day daily for 26 weeks B. Placebo electrical stimulation (n=36): placebo pulsed electrical stimulator worn 7 hours a day daily for 26 weeks | A vs. B Age: 71 vs. 69 years Female: 50% vs. 44% Baseline WOMAC total (0-100): 36 vs. 34 Baseline WOMAC function (0-100): 35 vs. 34 Baseline WOMAC stiffness (0-100): 45 vs. 41 Baseline WOMAC pain (0-100): 35 vs. 36 Baseline pain VAS (0-100): 51 vs. 52 | A vs. B 6.5 months Proportion of patients who achieved MCID (≥9.1) in WOMAC function: 38% vs. 39%, RR 1.2 (95% CI 0.6 to 2.2) Proportion of patients who achieved MCID (≥20) in pain VAS: 56% vs. 44%, RR 1.3 (95% CI 0.8 to 2.0) Mean change in WOMAC total: 6 vs. 7, MCD −1.3 (−8.8 to 6.3) Mean change in WOMAC function: 5 vs. 7, MCD −1.9 (95% CI −9.7 to 5.9) Mean change in WOMAC stiffness: 9 vs. 5, MCD 3.7 (95% CI −6.0 to 13.5) Mean change in WOMAC pain: 5 vs. 10, MCD −5.6 (95% CI −14.9 to 3.6) Mean change in pain VAS: 20 vs. 19, MCD 0.9 (95% CI −11.7 to 13.4) | A vs. B 6.5 months Mean change in SF-36 physical component score (0-100): −1.0 vs. −2.6, MCD 1.7 (95% CI −1.5 to 4.8) Mean change in SF-36 mental component score (0-100): −1.2 vs. −2.4, MCD 1.2 (95% CI −2.9 to 5.4) |
Fukuda, 2011155 12 months Duration of pain: NR Poor | A. Low-dose PSW (n=32): Three, 19 minute applications per week for3 weeks (9 total) Total Energy: 17 kJ Frequency: 27.12 MHz Mean Power Output: 14.5 W Pulse Duration: 400 microseconds Pulse Frequency: 145 Hz B. High-dose PSW (n=31): Treatment characteristics were identical to Group A except length of treatment (and received total energy) were doubled. Three, 38 min applications per week for3 weeks (9 total) Total Energy: 33 kJ C. Sham (n=23): Treatment characteristics were identical to Group A except the device was kept in standby mode without any electrical current applied. Three, 19 min applications per week for 3 weeks (9 total) | A vs. B vs. C Age: 62 vs. 63 vs. 57 Female: 100% Race: NR Baseline Knee Injury and Osteoarthritis Outcome Score Symptoms Subscale (0-100): 46.5 vs. 47.0 vs. 42.0 Baseline KOOS Daily Activities Subscale (0-100): 45.8 vs. 51.7 vs. 45.7 Baseline KOOS Recreational Activities Subscale (0-100): 16.6 vs. 15.3 vs. 18.2 Baseline KOOS Pain Subscale (0-100): 37.4 vs. 42.5 vs. 38.0 Baseline NRS Pain (0-10): 7.1 vs. 6.7 vs. 7.7 | A vs. C 12 months KOOS Symptoms Subscale: 61.6 vs. 40.7, difference 20.9 (95% 8.92 to 32.88) KOOS Daily Activities Subscale: 68.9 vs. 41.6, difference 27.30 (95% 13.73 to 40.87) KOOS Recreational Activities Subscale: 24.6 vs. 11.0, difference 13.6 (95% −0.73 to 27.93) KOOS Pain Subscale: 57.5 vs. 33.0, difference 24.5 (95% 12.12 to 36.88) NRS Pain: 5.7 vs. 7.5, difference −1.8 (95% −3.60 to 0.00) B vs. C 12 months KOOS Symptoms Subscale: 54.9 vs. 40.7, difference 14.2 (95% 1.21 to 27.19) KOOS Daily Activities Subscale: 51.9 vs. 41.6, difference 10.30 (95% −1.24 to 21.84) KOOS Recreational Activities Subscale: 15.9 vs. 11.0, difference 4.9 (95% −5.32 to 15.12) KOOS Pain Subscale: 57.6 vs. 33.0, difference 24.6 (95% 14.59 to 34.61) NRS Pain: 5.2 vs. 7.5, difference −2.3 (95% −3.68 to −0.92) | A vs. C 12 months KOOS Quality of Life Subscale (0-100): 31.8 vs. 33.0 B vs. C 12 months KOOS Quality of Life Subscale: 41.2 vs. 33.0 A vs. B vs. C Adverse Events: Went on to have a Total Knee Replacement during 12 month followup: 3.1% (1/32) vs. 6.5% (2/31) vs. 4.3% (1/23) |
Giombini, 2011156 3 months Duration of pain: 3 years Fair | A. Microwave diathermy (n=29): hyperthermic treatment 3 times a week for 4 weeks B. Sham diathermy (n=25): sham hyperthermic treatment 3 times a week for 4 weeks | A vs. B Age: 67 vs. 67 years Female: 66% vs. 68% Baseline WOMAC total (0-1.20): 103.1 vs. 101.3 Baseline WOMAC pain (0-25): 19.2 vs. 18.5 Baseline WOMAC stiffness (0-10): 9.7 vs. 9.7 Baseline WOMAC ADL (0-85): 74.3 vs. 73.1 | A vs. B 3 months Mean change in WOMAC total: −46.8 vs. −0.4, difference −46.4 (95% CI −58.3 to −34.5) Mean change in WOMAC pain; −8.6 vs. −0.6, difference −8.1 (95% CI −10.7 to −5.3) Mean change in WOMAC ADLs: −33 vs. 0.3, difference −33.2 (95% CI −42.0 to −24.6) Mean change in WOMAC stiffness: −5.2 vs. −0.1, difference −5.1, p<0.01 | NR |
Hegedus, 2009157 2 months Duration of pain NR Poor | A. Low-Level Laser Therapy (n=18): 50 mW, continuous wave laser (wavelength 830 nm). Total dose of 48 J/cm2 per session. Twice a week for 4 weeks. B. Placebo (n=17): Placebo probe (0.5 mW power output) used twice a week for 4 weeks. | Age: 49 Female: 81% A vs. B Baseline pain VAS (0-10): 5.8 vs. 5.6 | A vs. B 2 months Pain VAS: 1.2 vs. 4.1, difference −2.9 (no estimate of variability provided or calculable) | NR |
Jia, 2016163 1 and 3 months Duration of pain: NR Good [New trial] | A. Focused Low-Intensity Pulsed Ultrasound + diclofenac sodium (FLIPUS) (n=53): 20 minute sessions, once daily for 10 days applied to both knees. B. Sham Ultrasound + Diclofenac Sodium (FLIPUS) (n=53) | A vs. B Age: 63 vs. 61 years Female: 73.6% vs. 69.8% Baseline LI (0-24): 7.56 vs. 7.10 Baseline VAS (0-10): 6.98 vs. 6.76 | A vs. B Short-term (3 months) LI: 6.8 vs. 7.8, p=0.006; difference −1.1 (95% CI −1.9 to −0.3), p<0.01 VAS pain: 6.4 vs. 7.2, p=0.007 | NR |
Laufer, 2005158 3 months Duration of pain: NR Poor | A. Low Intensity Pulsed Shortwave Diathermy (n=38): Three, 20 min sessions per week for 3 weeks (9 total); Pulse Duration: 82 μs; Pulse Frequency: 110 Hz; Peak Power: 200 W (mean 1.8W) B. High Intensity Pulsed Shortwave Diathermy (n=32): Treatment protocol identical to Group A except with a higher intensity (pulse duration and frequency) Pulse Duration: 300 μs Pulse Frequency: 300 Hz Peak Power: 200 W (mean 18W) C. Sham Shortwave Diathermy (n=33): Identical treatment except the apparatus was turned on but the power output was not raised. | A vs. B vs. C Age: 75 vs. 73 vs. 73 Female: 82% vs. 91% vs. 67% Baseline WOMAC Overall: 5.1 vs. 4.6 vs. 5.0 Baseline WOMAC Stiffness: 4.9 vs. 4.3 vs. 4.92 Baseline WOMAC Activities of Daily Living: 5.2 vs. 4.7 vs. 5.1 Baseline WOMAC Pain: 4.9 vs. 4.4 vs. 5.0 | A vs. C 3 months WOMAC Overall: 4.8 vs. 4.6, difference 0.2 (95% CI −1.5 to 2.0) WOMAC Pain: 4.5 vs. 4.3, difference 0.2 (95% CI −1.6 to 1.9) WOMAC Stiffness: 4.4 vs. 3.6, difference 0.8 (95% CI −1.0 to 2.6) WOMAC Activities of Daily Living: 5.0 vs. 4.8, difference 0.2 (95% CI −1.5 to 1.8) B vs. C 3 months WOMAC Overall: 4.6 vs. 4.6, difference −0.04 (95% CI −1.8 to 1.7) WOMAC Pain: 4.1 vs. 4.3, difference −0.2 (95% CI −2.0 to 1.5) WOMAC Stiffness: 3.8 vs. 3.6, difference 0.2 (95% CI −1.6 to 2.0) WOMAC Activities of Daily Living: 4.8 vs. 4.8, difference −0.02 (95% CI −1.7 to 1.6) | A vs. B vs. C Adverse Events: No adverse reactions to the treatment were reported by the subjects. |
Mazzuca, 2004159 1 month Duration of pain: NR Fair | A. Superficial Heat (sleeve) (n=25): Cotton and lycra sleeve with a heat retaining polyester and aluminum substrate, minimum 12 hours/day; continue usual pain medication(s). B. Placebo Sleeve (n=24) Placebo sleeves did not contain the heat retaining substrate layer. | A + B Age: 62.7 Female: 77% Race: 67% white Baseline WOMAC Function (17-85)e: 51.8 (11.8) Baseline WOMAC Stiffness (2−10)e: 6.5 (1.4) Baseline WOMAC Pain (5-25)d: 15.2 vs. 14.7* | A vs. B 1 month WOMAC Pain: 13.7 vs. 13.9 | NR |
Tascioglu, 2004160 6 months Duration of pain: 7 years Poor | A. Active laser 3 joule (n=20) continuous laser therapy (50 mW, 830 mm wavelength) applied to 5 painful points 5 days a week for 2 weeks B. Active laser 1.5 joule (n=20): continuous laser therapy (50 mW, 830 mm wavelength) applied to 5 painful points 5 days a week for 2 weeks C. Placebo laser (n=20): sham laser therapy applied to 5 painful points 5 days a week for 2 weeks | A vs. B vs. C Age: 63 vs. 60 vs. 64 years Female: 70% vs. 75% vs. 65% Baseline WOMAC function (0-68):36.6 vs. 38.0 vs. 39.5 Baseline WOMAC stiffness (0-8): 4.1 vs. 4.6 vs. 4.5 Baseline WOMAC pain (0-20): 10.3 vs. 11.6 vs. 9.6 Baseline pain at rest VAS (0-100): 39.1 vs. 41.6 vs. 37.9 Baseline pain at activation VAS (0-100): 68.0 vs. 65.7 vs. 63.9 | A vs. C 6 months WOMAC function: 34.8 vs. 38.7, difference −3.8 (95% CI −9.8 to 2.1) WOMAC stiffness: 3.9 vs. 4.2, difference −0.3 (95% CI −1.6 to 0.9) WOMAC pain: 10.4 vs. 9.9, difference 0.6 (95% CI −1.5 to 2.7) Pain at rest VAS: 38.7 vs. 38.9, difference −0.3 (95% CI −9.8 to 9.3) Pain at activation VAS: 66.8 vs. 62.0, difference 4.8 (95% CI −4.9 to 14.5) B vs. C 6 months WOMAC function: 38.5 vs. 38.7 WOMAC stiffness: 4.5 vs. 4.2 WOMAC pain: 11.3 vs. 9.9 Pain at rest VAS: 40.0 vs. 38.9 Pain at activation VAS: 61.8 vs. 62.0 | NR |
Thamsborg, 2005161 1.5 month Duration of pain: 8 years Fair | A. Pulsed Electromagnetic Fields (n=42): ±50V in 50Hz pulses changing voltage in 3 ms intervals; 2-hour sessions, daily, 5 days per week for 6 weeks (30 total) B. Sham Electromagnetic Field (n=41): noneffective placebo electromagnetic field; 2 hour sessions, daily, 5 days per week for 6 weeks (30 total) | A vs. B Age: 60 vs. 60 Female: 47.6% vs. 61% Race: NR Baseline WOMAC Activities of Daily Living (0-85): 43.83 vs. 46.49 Baseline WOMAC Stiffness (0-10): 5.74 vs. 5.85 Baseline WOMAC Joint Pain (0-25): 13.15 vs. 14.49 | A vs. B 1.5 months WOMAC Activities of Daily Living: 37.9 vs. 41.3, difference −3.5 (95% CI −4.4 to −2.5) WOMAC Stiffness: 4.8 vs. 5.2, difference −0.3 (95% CI −0.5 to −0.2) WOMAC Joint Pain: 11.4 vs. 12.2, difference −0.8 (95% CI −1.1 to −0.6) | A vs. B Adverse Events: throbbing sensation, warming sensations or aggravation of pain 28.5% (12/42) vs. 14.6% (6/41) |
Yegin, 2017164 1 month Duration of pain: NR Poor [New trial] | A. Continuous Ultrasound (n=30): 8 minutes to each knee (16 minutes total), 5 days a week for 2 weeks (10 sessions total) B. Sham Ultrasound (n=32): Identical protocol but with device in off mode, and out of view of patient All patients: use of analgesics was avoided during treatment until end of first month following completed treatment. | No population details provided Baseline WOMAC-ADL (0-170): 27.3 vs. 27.7 Baseline WOMAC-Stiffness (0-20): 3 vs. 3.5 Baseline VAS-Mobility (0-10): 5 vs. 5.5 Baseline VAS-At Rest (0-10):1.6 vs. 2.5 Baseline LI-Pain 0-10): 5 vs. 4.5 WOMAC-Pain (0-50): 8.5 vs. 9.3 | A vs. B Short Term (1 month) Mean WOMAC-ADL: 18.0 vs. 21.2; mean Δ −9.3 vs. −6.5, p=0.414 Median WOMAC-Stiffness: 1.0 vs. 1.5; median Δ −1.0 vs. 1.0, p=0.614 Median LI-ADL: 3.8 vs. 4.5; median Δ −1.0 vs. −0.5, p=0.490 Median VAS-Mobility: 3.5 vs. 3.0; median Δ −1.0 vs. −2.0, p=0.680 Median VAS-At Rest: 0.1 vs. 0.3; median Δ 0.0 vs. 0.0, p=0.513 Median LI-Pain: 3.0 vs. 3.0; median Δ −1.5 vs. −0.5, p=0.153 Mean WOMAC-Pain: 5.6 vs. 6.6; mean Δ −2.9 vs. −2.6, p=0.77 | A vs. B Short Term (1 month) SF-36 PCS (0-100): 43.0 vs. 40.0; mean Δ 7.9 vs. 6.1, p=0.466 SF-36 MCS (0-100): 45.2 vs. 46.7; mean Δ −0.3 vs. −0.1, p=0.949 SF-36 Pain: 44.3 vs. 41.4; mean Δ 8.3 vs. 5.4, p=0.247 SF-36 Emotional Role: 55.3 vs. 55.3; median Δ 0.0 vs. 0.0, p=0.790 SF-36 Energy-Vitality: 43.2 vs. 44.8; mean Δ 0.6 vs. 0.7, p=0.943 SF-36 Physical Function: 44.6 vs. 44.6; median Δ 5.3 vs. 2.1, p=0.383 SF-36 Physical Role: 56.2 vs. 56.2; median Δ 0.0 vs. 0.0, p=0.597 SF-36 General Health: 40.6 vs. 40.6; median Δ 0.0 vs. 0.0, p=0.556 SF-36 Mental Health: 44.75 vs. 40.25; median Δ 4.6 vs. 0.0, p=0.072 SF-36 Social Function: 54.4 vs. 57.1; median Δ 0.0 vs. 0.0, p=0.785 |
Yildiz, 2015162 2 months Duration of pain: Mean 2.8 to 5.1 years Fair | A. Continuous ultrasound (n=30): 5 times a week for 2 weeks B. Pulsed ultrasound (n=30): 5 times a week for 2 weeks C. Sham (n=30): 5 times a week for 2 weeks All patients performed home exercise program 3 days a week for 8 weeks | A vs. B vs. C Age: 56 vs. 55 vs. 58 years Female: 83% vs. 80% vs. 87% Baseline Lequesne Index score (0-24): 13.2 vs. 12.9 vs. 12.4 Baseline pain at rest VAS (0-10): NR Baseline pain on movement VAS (0-10): 9.0 vs. 8.6 vs. 8.9 | A vs. C 2 months Lequesne Index: 5.5 vs. 11.7, difference −6.2 (95% CI −8.4 to 4.2) Pain on movement VAS: 3.9 vs. 7.2, difference −3.3 (95% CI −4.6 to −2.0) B vs. C 2 months Lequesne Index: 6.0 vs. 11.7, difference −5.7 (95% CI −7.7 to −3.7) Pain on movement VAS: 3.8 vs. 7.2, difference −3.4 (95% CI −4.7 to −2.0) | NR |
ADL = activity of daily living; CI = confidence interval; EQ-5D = EuroQol Quality of Life Instrument 5-D; HSS = Hospital for Special Surgery; Hz = hertz; J/cm2 – Joules per square centimeter; kJ = kilojoules; KOOS = Knee Injury and Osteoarthritis Outcome Score; LI = Lequesne Index; MCID = minimal clinically important difference; MHz = Mega Hertz; mW = mega Watts; nm = nanometer; NR = not reported; NRS = numeric rating scale; PSW = pulsed short wave; RR = risk ratio; SKFS = Saudi Knee Function Score; SF-36 MCS = Short Form 36 Questionnaire Mental Component Score; TENS = transcutaneous electrical nerve stimulation; VAS = visual analog scale; W = watts; WOMAC = Western Ontario and McMaster Universities Osteoarthritis Index; μs = microsecond
Unless otherwise noted, followup time is calculated from the end of the treatment period
Values estimated from graph
The study separated outcome values out into slight, moderate and severe disease patient groups for each treatment arm. These values are combined values for each intervention groups estimated from graphs in the study.
Values estimated from graph
Separate group baseline values not given for stiffness and function subscales
Age only reported for population as a whole
From: Results
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