Pulsed Electromagnetic Field and Exercises in Patients With Shoulder Impingement Syndrome: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

doi:10.1016/j.apmr.2013.09.022

Archives of Physical Medicine and Rehabilitation

Volume 95, Issue 2, February 2014, Pages 345-352

https://doi.org/10.1016/j.apmr.2013.09.022 Get rights and content

Abstract

Objective

To evaluate the effects of pulsed electromagnetic field (PEMF) and exercises in reducing pain and improving function and muscle strength in patients with shoulder impingement syndrome (SIS).

Design

Double-blind, randomized controlled trial with a 3-month posttreatment follow-up.

Setting

Outpatient rehabilitation of a public hospital.

Participants

Patients (N=56) between 40 and 60 years of age, with a diagnosis of SIS, were randomly assigned to receive active PEMF (n=26; mean age, 50.1y) or placebo PEMF (n=30; mean age, 50.8y).

Interventions

After 3 weeks of active or placebo PEMF, both groups performed the same program of exercises that focused on shoulder strengthening.

Main Outcome Measures

A visual analog scale, the University of California/Los Angeles shoulder rating scale, the Constant-Murley shoulder score, and handheld dynamometry for muscle strength were used as outcome measures at baseline (pretreatment), at 3 weeks (after active or placebo PEMF), at 9 weeks (postexercise), and at 3 months posttreatment.

Results

Patients in the active PEMF group had a higher level of function and less pain at all follow-up time frames compared with baseline (P<.05). However, the placebo PEMF group had increased function and reduced pain only at the 9-week and 3-month follow-ups (P<.05)—that is, after performing the associated exercises. For the shoulder dynamometry, the active PEMF group had increased strength for lateral rotation at 9 weeks (P<.05), and increased strength for medial rotation at 9 weeks and 3 months (both P<.05) when compared with baseline. There was no significant difference for shoulder strength in the placebo PEMF group (P>.05), as well as no significant differences (P>.05) for all outcome measures.

Conclusions

The combination of PEMF and shoulder exercises is effective in improving function and muscle strength and decreasing pain in patients with SIS. However, these results should be carefully interpreted because of the lack of differences between groups.

Section snippets

Participants

Fifty-six patients aged 40 to 60 years (N=56; mean age ± SD, 50.5±8.9y), with a diagnosis of SIS, were randomly assigned to receive active PEMF (n=26; mean age ± SD, 50.1±8.2y) or placebo PEMF (n=30; mean age ± SD, 50.8±9.6y). After 3 weeks of active or placebo PEMF, both groups performed the same program of exercises focusing on shoulder strengthening. Four patients who were in the active PEMF group and 6 patients who were in the placebo PEMF group did not complete the study. All study

Results

At 3 months, 4 subjects in the active PEMF group and 6 subjects in the placebo PEMF group were lost during follow-up. Therefore, all per-protocol data analyses were performed with 22 subjects in the active PEMF group and 24 subjects in the placebo PEMF group.

Discussion

The results of this randomized controlled trial demonstrated that a 3-week intervention with PEMF is effective for improving function and reducing pain in patients with SIS. A combination of shoulder exercises is essential for increasing muscle strength and increasing the overall effectiveness of these improvements. Both active and placebo PEMF groups showed improvements for all functional and pain outcome measures when combined with shoulder exercises. The group that received active PEMF and

Conclusions

Our findings suggest that the combination of PEMF and shoulder exercises is effective in improving function and muscle strength and decreasing pain in patients with SIS. However, these results should be carefully interpreted because of the lack of between-group differences.

Suppliers

a.
Meditea, Viamonte 2255 / 2265, Buenos Aires, Argentina.
b.
Lafayette Instrument Co, PO Box 5729, Lafayette, IN 47903.
c.
SPSS Inc, 233 S Wacker Dr, 11th Fl, Chicago, IL 60606.

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To determine the reproducibility of exercise therapy interventions in randomized controlled trials for rotator cuff-related shoulder pain (RCRSP).
Data sources included Medline, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, and SPORTDiscus from studies published from database inception to April 23, 2022.
Randomized controlled trials studying the use of exercise therapy for RCRSP.
Two reviewers extracted exercise reporting details from all studies using the Template for Intervention Description and Replication (TIDieR) and the modified Consensus on Exercise Reporting Template (CERT). The same 2 reviewers assessed risk of bias of all studies using Cochrane Risk of Bias Tool version 2.0.
For 104 studies meeting inclusion criteria, the average number of items reported on the TIDieR was 5.27 (SD 2.50, range 1-12 out of 12) and 5.09 (SD 4.01, range 0-16 out of 16) on the CERT. Improved reporting over time was seen on both the TIDieR and CERT dating back to 1993 and through April 23, 2022. When comparing groups of studies published before and after the TIDieR (2014) and CERT (2016) were established, a statistically significant increase in median scores was noted on the TIDieR (P=.02) but not the CERT (P=.31). Quality of exercise therapy reporting was highest in studies with “low risk” of bias, and lowest in studies with “high risk” of bias on the RoB-2.
Overall exercise reporting in trials for RCRSP is incomplete despite the development of the TIDieR and CERT checklists. This has implications for translating evidence into practice.
Effectiveness of Pulse Electromagnetic Field Therapy in Patients With Subacromial Impingement Syndrome: A Double-Blind Randomized Sham Controlled Study
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To evaluate the 3-month effects of pulsed electromagnetic field therapy (PEMF) in the treatment of subacromial impingement syndrome (SIS).
Planned analysis of a randomized controlled trial with 4- and 12-week follow-ups.
Physical medicine and rehabilitation clinic, treatment unit.
Of the 250 individuals screened for eligibility, participants with a diagnosis of SIS (N=80) were randomized to intervention or control groups.
The first group received PEMF + exercise and the second group received sham PEMF + exercise 5 days a week for a total of 20 sessions.
Visual Analog Scale (VAS), Constant Murley Score (CMS), Shoulder Pain and Disability Index (SPADI), Short Form-36 (SF-36) Quality of Life Questionnaire, and shoulder muscle strength measurement with an isokinetic dynamometer. Evaluations were performed before treatment (T0), after treatment (T1), and 12th week (T2).
Evaluation at T1 and T2 showed improvement in most parameters in both groups compared with baseline. In the comparison between the 2 groups at T1 and T2, more improvement was found in the PEMF group in most parameters.
In our study, PEMF was found to be superior to sham PEMF in terms of pain, ROM, functionality, and quality of life at the first and third months.
Physical Therapy Combined With Subacromial Cortisone Injection Is a First-Line Treatment Whereas Acromioplasty With Physical Therapy Is Best if Nonoperative Interventions Fail for the Management of Subacromial Impingement: A Systematic Review and Network Meta-Analysis
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Citation Excerpt :
Alpha was set at 0.05 and all analyses were conducted in RStudio software, version 1.2.1335 (R Foundation for Statistical Computing, Vienna, Austria). The systematic literature search identified a total of 11,085 studies, of which 35 met eligibility criteria and were included in the meta-analysis (Fig 1, Table 2).19,20,22,26,27,39,42,52-54,63-87 The 35 studies included a total of 3,643 shoulders and 42% of patients were female (Table 3).
To construct an algorithm to optimize clinical outcomes in subacromial impingement based on current, high-level evidence.
A systematic review of all clinical trials on subacromial impingement published from 1999 to 2020 was performed. Demographic, clinical, range of motion (ROM), and patient-reported outcome measure (PROM) data were collected. Interventions were compared via arm-based Bayesian network meta-analysis in a random-effects model and treatments ranked via surface under the cumulative ranking curves with respect to 3 domains: pain, PROMs, and ROM.
A total of 35 studies comprising 3,643 shoulders (42% female, age 50 ± 5 years) were included. Arthroscopic decompression with acromioplasty ranked much greater than arthroscopic decompression alone for pain relief and PROM improvement, but the difference in absolute PROMs was not statistically significant. Corticosteroid injection (CSI) alone demonstrated inferior outcomes across all 3 domains (pain, PROMs, and ROM) with low cumulative rankings. Physical therapy (PT) with CSI demonstrated moderate-to-excellent clinical improvement across all 3 domains whereas PT alone demonstrated excellent ROM and low-moderate outcomes in pain and PROM domains. PT with nonsteroidal anti-inflammatory drugs or alternative therapies ranked highly for PROM outcomes and moderate for pain and ROM domains. Finally, platelet-rich plasma injections demonstrated moderate outcomes for pain, forward flexion, and abduction with very low-ranking outcomes for PROMs and external rotation.
Arthroscopic decompression with acromioplasty and PT demonstrated superior outcomes whereas CSI demonstrated poor outcomes in all 3 domains (pain, PROMs, and ROM). For patients with significant symptoms, the authors recommend PT with CSI as a first-line treatment, followed by acromioplasty and PT if conservative treatment fails. For patients with symptoms limited to 1 to 2 domains, the authors recommend a shared decision-making approach focusing on treatment rankings within domains pertinent to individual patient symptomatology.
I, systematic review and network meta-analysis of Level I studies.
Electromagnetic Transduction Therapy for Achilles Tendinopathy: A Preliminary Report on a New Technology
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The heel cushion size of 10 mm in the present study appears thicker than that used in other studies, which typically used a lower thickness (17). Other types of electromagnetic modalities have been critically studied for soft tissue injury in humans; however, these have typically involved the shoulder (14,16). The modality most stringently studied for mid-portion Achilles tendinopathy is ESWT/RSWT, the reference standard (7,8).
A parallel prospective feasibility study was performed on 53 patients with chronic mid-portion Achilles tendinopathy (age 44.7 ± 9.1 years). Of the 53 patients, 28 (active group) were treated using a new electromagnetic (pulsed electromagnetic field) transduction therapy device (Cellactor^® MT1) and heel cushions. The device produces an electromagnetic field of 80 milliTesla; a total of 8 treatments was performed within 4 weeks in an outpatient setting, without anesthesia, immobilization, or rest. A control group of 25 patients with a similar duration of symptoms was treated with heel cushions only. At the 12-week assessment point, the visual analog scale scores in both groups had significantly decreased, although the active group had significantly improved visual analog scale scores compared with those of the controls. The Role-Maudsley scores had also significantly improved in both the active and the control groups (p < .00001 and p = .0002, respectively). Electromagnetic transduction therapy could potentially be a useful modality for the treatment of Achilles tendinopathy. It should be compared with the current reference standard of extracorporeal shockwave therapy/radial soundwave therapy with similar level I, II, and III studies.
Combined Use of Diadynamic Currents and Manual Therapy on Myofascial Trigger Points in Patients With Shoulder Impingement Syndrome: A Randomized Controlled Trial
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Kaya et al30 found no differences between Kinesio Taping with exercise and MT with exercise, as both methods achieved similar results in reducing pain and disability in subacromial impingement after 6 weeks of treatment. Considering the use of physical agents on patients with shoulder impingement syndrome, Galace de Freitas et al31 found that patients treated with exercises and a pulsed electromagnetic field experienced increases in both muscle strength and function as well as a greater reduction in pain intensity when compared to a group submitted to exercises and sham pulsed electromagnetic field (machine switched off). Yavuz et al32 compared the effects of therapeutic laser and ultrasound in patients with subacromial impingement syndrome and found that both treatments led to reductions in pain and functional disability.
The purpose of this study was to evaluate the effect of combined manual therapy (MT) and diadynamic (DD) currents on myofascial trigger points of the upper trapezius muscle in individuals with a diagnosis of unilateral shoulder impingement syndrome.
A randomized clinical trial was conducted involving 60 individuals with shoulder impingement syndrome who were allocated to the following 3 groups: (1) MT and DD currents (MTDD), (2) MT alone, and (3) DD currents alone. The participants were submitted to 16 treatment sessions over an 8-week period and were evaluated using the Numerical Rating Pain Scale as well as the pain and disability subscales of the Shoulder Pain and Disability Index.
Differences in Numerical Rating Pain Scale scores (secondary outcome) between MTDD and MT groups (mean difference 2.25 points, 95% confidence interval 1.07-3.42) and between MTDD and DD groups (mean difference 2.30 points, 95% confidence interval 1.42-3.17) were clinically relevant. No clinical gains were observed in the comparisons between groups of Shoulder Pain and Disability Index scores.
The combination of MT and DD currents on myofascial trigger points was more effective at reducing pain intensity but not disability than each therapy performed individually for patients with unilateral shoulder impingement syndrome.
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: Clinical Trial Registration No.: NCT01452204.

: No commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a benefit on the authors or on any organization with which the authors are associated.

View full text

Original articlePulsed Electromagnetic Field and Exercises in Patients With Shoulder Impingement Syndrome: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Abstract

Objective

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Section snippets

Participants

Results

Discussion

Conclusions

Suppliers

Clin Biomech (Bristol, Avon)

Arch Phys Med Rehabil

J Hand Surg [Am]

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Clin Epidemiol

J Shoulder Elbow Surg

Arch Phys Med Rehabil

Lancet

Screening the athlete's shoulder for impingement symptoms: a clinical reasoning algorithm for early detection of shoulder pathology

Br J Sports Med

Shoulder impingement syndrome: correlations between clinical tests and ultrasonographic findings

Ortop Traumatol Rehabil

Subacromial space width changes during abduction and rotation: a 3-D MR imaging study

Surg Radiol Anat

Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report

J Bone Joint Surg Am

Exercises versus arthroscopic decompression in patients with subacromial impingement: a randomised, controlled study in 90 cases with a one year follow up

Ann Rheum Dis

Progressive resistance training in patients with shoulder impingement syndrome: a randomized controlled trial

Arthritis Rheum

Effects of local microwave diathermy on shoulder pain and function in patients with rotator cuff tendinopathy in comparison to subacromial corticosteroid injections: a single-blind randomized trial

J Orthop Sports Phys Ther

Pulsed electromagnetic energy treatment offers no clinical benefit in reducing the pain of knee osteoarthritis: a systematic review

BMC Musculoskelet Disord

Therapeutic uses of pulsed magnetic-field exposure: a review

Radio Sci Bull

Original article
Pulsed Electromagnetic Field and Exercises in Patients With Shoulder Impingement Syndrome: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial