Department of Surgery, Oncology, and Stomatology, University of Palermo, 90133 Palermo, Italy.
Department of Physical and Mental Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", 80100 Naples, Italy.
Medicina (Kaunas). 2021 Oct 26;57(11):1165. doi: 10.3390/medicina57111165.
Early osteoarthritis (EOA) still represents a challenge for clinicians. Although there is no consensus on its definition and diagnosis, a prompt therapeutic intervention in the early stages can have a significant impact on function and quality of life. Exercise remains a core treatment for EOA; however, several physical modalities are commonly used in this population. The purpose of this paper is to investigate the role of physical agents in the treatment of EOA. A technical expert panel (TEP) of 8 medical specialists with expertise in physical agent modalities and musculoskeletal conditions performed the review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) model. The TEP searched for evidence of the following physical modalities in the management of EOA: "Electric Stimulation Therapy", "Pulsed Electromagnetic field", "Low-Level Light Therapy", "Laser Therapy", "Magnetic Field Therapy", "Extracorporeal Shockwave Therapy", "Hyperthermia, Induced", "Cryotherapy", "Vibration therapy", "Whole Body Vibration", "Physical Therapy Modalities". We found preclinical and clinical data on transcutaneous electrical nerve stimulation (TENS), extracorporeal shockwave therapy (ESWT), low-intensity pulsed ultrasound (LIPUS), pulsed electromagnetic fields stimulation (PEMF), and whole-body vibration (WBV) for the treatment of knee EOA. We found two clinical studies about TENS and PEMF and six preclinical studies-three about ESWT, one about WBV, one about PEMF, and one about LIPUS. The preclinical studies demonstrated several biological effects on EOA of physical modalities, suggesting potential disease-modifying effects. However, this role should be better investigated in further clinical studies, considering the limited data on the use of these interventions for EOA patients.
早期骨关节炎（EOA）仍然是临床医生面临的挑战。尽管其定义和诊断尚未达成共识，但在早期阶段进行及时的治疗干预对功能和生活质量有重大影响。运动仍然是 EOA 的核心治疗方法；然而，该人群中通常会使用几种物理疗法。本文旨在探讨物理因子在 EOA 治疗中的作用。一个由 8 名具有物理因子模式和肌肉骨骼疾病专业知识的医学专家组成的技术专家小组（TEP）按照 PRISMA-ScR（系统评价和荟萃分析扩展的首选报告项目）模型进行了综述。TEP 搜索了以下物理疗法在 EOA 管理中的证据：“电刺激疗法”、“脉冲电磁场”、“低水平光疗”、“激光疗法”、“磁场疗法”、“体外冲击波疗法”、“诱导性热疗”、“冷冻疗法”、“振动疗法”、“全身振动”、“物理治疗模式”。我们发现了经皮神经电刺激（TENS）、体外冲击波疗法（ESWT）、低强度脉冲超声（LIPUS）、脉冲电磁场刺激（PEMF）和全身振动（WBV）治疗膝关节 EOA 的临床前和临床数据。我们发现了两项关于 TENS 和 PEMF 的临床研究以及六项临床前研究——三项关于 ESWT、一项关于 WBV、一项关于 PEMF 和一项关于 LIPUS。临床前研究表明，物理疗法对 EOA 具有多种生物学效应，提示可能具有疾病修饰作用。然而，鉴于这些干预措施在 EOA 患者中的使用数据有限，应在进一步的临床研究中更好地研究其作用。
