Efectividad de la terapia combinada en fisioterapia para el manejo del dolor musculoesquelético : revisión sistemática y metaanálisis
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Fecha
2022
Profesor/a Guía
Facultad/escuela
Idioma
es
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Universidad Andrés Bello
Nombre de Curso
Licencia CC
Licencia CC
Resumen
Introducción: El ultrasonido terapéutico y la electroterapia se utilizan en terapia física comúnmente para el manejo del dolor musculoesquelético (DME). La terapia combinada (CT) es un recurso que fusiona ambas técnicas, potenciando los efectos analgésicos de ambos tratamientos, aunque pareciera ser que los estudios son limitados. Objetivo: Determinar la efectividad de la CT en un programa de terapia física para el manejo del DME. Materiales y método: Se realizaron búsquedas de ensayos clínicos aleatorios (ECAs) en las bases de datos PubMed, Web of Science, Scopus, Cinahl, Science Direct y PEDro (última actualización 30 de agosto de 2022). Se incluyeron ECAs que compararon la CT con otros tratamientos de terapia física para el DME. Trece estudios cumplieron con los criterios de elegibilidad y se incluyeron para la síntesis cualitativa. La calidad de los artículos se evaluó mediante la herramienta Rob2 de Cochrane. Resultados: Los ECAs fueron evaluados con un bajo riesgo de sesgo para todos los dominios de RoB2. La síntesis cualitativa reporta disminución del dolor, aumento del ROM y menor discapacidad en favor de CT, aunque, el análisis cuantitativo muestra solo tamaños de efecto grandes estadísticamente significativos (p75%) modera su grado de recomendación. Conclusión: Esta SR muestra que la CT presenta mejores efectos analgésicos que TENS, corrientes interferenciales o ultrasonido terapéutico. Se sugiere utilizar las recomendaciones posológicas de esta revisión para la práctica clínica y nuevas investigaciones con CT.
Introduction: Therapeutic ultrasound and electrotherapy are used commonly in physical therapy for musculoskeletal pain (MSP) management. Combined therapy (CT) is a resource that merges both techniques, enhancing the analgesic effects of both treatments, although studies are limited. Objective: To determine the effectiveness of CT in a physical therapy for the management of MSP. Materials and method: PubMed, Web of Science, Scopus, Cinahl, Science Direct, and PEDro databases were searched for randomized clinical trials (RCTs) (updated August 30, 2022). RCTs comparing CT with other physical therapy treatments for DME were included. Thirteen studies met the eligibility criteria, including those in the qualitative synthesis and meta-analysis. Cochrane Rob2 tool was used to assess the article´s quality. Results: RCTs were assessed as having a low risk of bias for all RoB2 domains. Although the qualitative synthesis reports a reduction in pain, an increase in ROM, and less disability in favor of CT, the quantitative analysis only shows large, statistically significant effect sizes (p 0.05) for thestandardized mean differences (SMD) in pain (SMD=0.92;CI=0.75,1.09) and ROM (SMD=-0.93;CI=- 1.07,-0.78). When the pooled effect of CT with interferential currents is considered, the analgesic benefits improve (SMD=-1.54;IC=-1.84,-1.25). Although the analgesic evidence was qualified as important, the heterogeneity obtained in the studies (I2>75%) moderates its degree of recommendation. Conclusion: This SR shows that CT has better analgesic effects than TENS, interferential currents, or therapeutic ultrasound. It is suggested to use the dosage recommendations of this review for clinical practice and new investigations with CT.
Introduction: Therapeutic ultrasound and electrotherapy are used commonly in physical therapy for musculoskeletal pain (MSP) management. Combined therapy (CT) is a resource that merges both techniques, enhancing the analgesic effects of both treatments, although studies are limited. Objective: To determine the effectiveness of CT in a physical therapy for the management of MSP. Materials and method: PubMed, Web of Science, Scopus, Cinahl, Science Direct, and PEDro databases were searched for randomized clinical trials (RCTs) (updated August 30, 2022). RCTs comparing CT with other physical therapy treatments for DME were included. Thirteen studies met the eligibility criteria, including those in the qualitative synthesis and meta-analysis. Cochrane Rob2 tool was used to assess the article´s quality. Results: RCTs were assessed as having a low risk of bias for all RoB2 domains. Although the qualitative synthesis reports a reduction in pain, an increase in ROM, and less disability in favor of CT, the quantitative analysis only shows large, statistically significant effect sizes (p 0.05) for thestandardized mean differences (SMD) in pain (SMD=0.92;CI=0.75,1.09) and ROM (SMD=-0.93;CI=- 1.07,-0.78). When the pooled effect of CT with interferential currents is considered, the analgesic benefits improve (SMD=-1.54;IC=-1.84,-1.25). Although the analgesic evidence was qualified as important, the heterogeneity obtained in the studies (I2>75%) moderates its degree of recommendation. Conclusion: This SR shows that CT has better analgesic effects than TENS, interferential currents, or therapeutic ultrasound. It is suggested to use the dosage recommendations of this review for clinical practice and new investigations with CT.
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Tesis (Kinesiólogo)
Palabras clave
Manejo del Dolor, Terapia por Estimulación Eléctrica, Fisioterapia