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Campos electromagnéticos para el tratamiento de la osteoartritis

Appendices

Appendix 1. MEDLINE search strategy

MEDLINE updated to 3 October 2013

1. exp osteoarthritis/

2. osteoarthr$.tw.

3. (degenerative adj2 arthritis).tw.

4. arthrosis.tw.

5. or/1‐4

6. Electromagnetic Fields/

7. electromagnetic$.tw.

8. exp Electric Stimulation Therapy/

9. pulsed.tw.

10. (electric$ adj3 stimulat$).tw.

11. (alternat$ adj3 electric$).tw.

12. physical therapy modalities/

13. (physical adj therap$).tw.

14. physiotherap$.tw.

15. or/6‐14

16. 5 and 15

17. randomized controlled trial.pt.

18. controlled clinical trial.pt.

19. randomized.ab.

20. placebo.ab.

21. drug therapy.fs.

22. randomly.ab.

23. trial.ab.

24. groups.ab.

25. or/17‐24

26. (animals not (humans and animals)).sh.

27. 25 not 26

28. 16 and 27

Appendix 2. CINAHL search strategy

CINAHL updated to 3 October 2013

S30 S16 and S29

S29 S17 or S18 or S19 or S20 or S21 or S22 or S23 or S24 or S25 or S26 or S27 or S28

S28 TI Allocat* random* or AB Allocat* random*

S27 (MH "Quantitative Studies")

S26 (MH "Placebos")

S25 TI Placebo* or AB Placebo*

S24 TI Random* allocat* or AB Random* allocat* Search S23 (MH "Random Assignment")

S22 TI Randomi?ed control* trial* or AB Randomi?ed control* trial*

S21 AB singl* blind* or AB singl* mask* or AB doub* blind* or AB doubl* mask* or AB trebl* blind* or AB trebl* mask* or AB

tripl* blind* or AB tripl* mask*

S20 TI singl* blind* or TI singl* mask* or TI doub* blind* or TI doubl* mask* or TI trebl* blind* or TI trebl* mask* or TI tripl*

blind* or TI tripl* mask*

S19 TI clinical* trial* or AB clinical* trial*

S18 PT clinical trial

S17 (MH "Clinical Trials+")

S16 S5 and S15

S15 S6 or S7 or S8 or S9 or S10 or S11 or S12 or S13 or S14

S14 ti physiotherap* or ab physiotherap*

S13 ti physical therap* or ab physical therap* Search

S12 (MH "Physical Therapy+")

S11 ti alternat* N3 electric* or ab alternat* N3 electric*

S10 ti electric$* N3 stimulat* or ab electric$* N3 stimulat*

S9 ti pulsed or ab pulsed

S8 (MH "Electric Stimulation+")

S7 ti electromagnetic* or ab electromagnetic*

S6 (MH "Electromagnetic Fields")

S5 S1 or S2 or S3 or S4

S4 ti arthrosis or ab arthrosis

S3 ti degenerative N2 arthritis or ab degenerative N2 arthritis

S2 ti osteoarthr* or ab osteoarthr*

S1 (MH "Osteoarthritis+")

Appendix 3. EMBASE search strategy

EMBASE updated to 3 October 2013

1. exp osteoarthritis/

2. osteoarthr$.tw.

3. (degenerative adj2 arthritis).tw.

4. arthrosis.tw.

5. or/1‐4

6. electromagnetic field/

7. electromagnetic$.tw.

8. exp electrostimulation therapy/

9. pulsed.tw.

10. (electric$ adj3 stimulat$).tw.

11. (alternat$ adj3 electric$).tw.

12. exp physiotherapy/

13. (physical adj therap$).tw.

14. physiotherap$.tw.

15. or/6‐14

16. 5 and 15

17. (random$ or placebo$).ti,ab.

18. ((single$ or double$ or triple$ or treble$) and (blind$ or mask$)).ti,ab.

19. controlled clinical trial$.ti,ab.

20. RETRACTED ARTICLE/

21. or/17‐20

22. (animal$ not human$).sh,hw.

23. 21 not 22

24. 16 and 23

Appendix 4. CENTRAL search strategy

CENTRAL updated to Issue 9, 2013

#1 MeSH descriptor Osteoarthritis explode all trees

#2 degenerative near/2 arthritis

#3 osteoarthr*

#4 arthrosis:ti,ab

#5 (#1 OR #2 OR #3 OR #4)

#6 MeSH descriptor Electromagnetic Fields explode all trees

#7 electromagnetic*:ti,ab

#8 MeSH descriptor Electric Stimulation Therapy explode all trees

#9 pulsed:ti,ab

#10 electric* near/3 stimulat*:ti,ab

#11 alternat* near/3 electric*:ti,ab

#12 MeSH descriptor Physical Therapy Modalities explode all trees

#13 physical next therap*:ti,ab

#14 physiotherap*:ti,ab

#15 (#6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14)

#16 (#5 AND #15)

Appendix 5. PEDro search strategy

PEDro updated to 3 October 2013

Abstract and title: electro

Subdiscipline: musculoskeletal

Abstract and title: osteoarthritis

Therapy: electrotherapies, heat and cold

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 2

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 3

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Electromagnetic fields versus placebo for osteoarthritis, Outcome 1 Pain.
Figures and Tables -
Analysis 1.1

Comparison 1 Electromagnetic fields versus placebo for osteoarthritis, Outcome 1 Pain.

Comparison 1 Electromagnetic fields versus placebo for osteoarthritis, Outcome 2 Physical function.
Figures and Tables -
Analysis 1.2

Comparison 1 Electromagnetic fields versus placebo for osteoarthritis, Outcome 2 Physical function.

Comparison 1 Electromagnetic fields versus placebo for osteoarthritis, Outcome 3 Quality of life.
Figures and Tables -
Analysis 1.3

Comparison 1 Electromagnetic fields versus placebo for osteoarthritis, Outcome 3 Quality of life.

Comparison 1 Electromagnetic fields versus placebo for osteoarthritis, Outcome 4 Number of patients experiencing any adverse event.
Figures and Tables -
Analysis 1.4

Comparison 1 Electromagnetic fields versus placebo for osteoarthritis, Outcome 4 Number of patients experiencing any adverse event.

Comparison 1 Electromagnetic fields versus placebo for osteoarthritis, Outcome 5 Number of patients who withdrew because of adverse events.
Figures and Tables -
Analysis 1.5

Comparison 1 Electromagnetic fields versus placebo for osteoarthritis, Outcome 5 Number of patients who withdrew because of adverse events.

Summary of findings for the main comparison. Electromagnetic field treatment compared to placebo for the treatment of osteoarthritis

Electromagnetic field treatment compared to placebo for the treatment of osteoarthritis

Patient or population: patients with osteoarthritis
Settings: out‐patients recruited from healthcare facilities in Australia, Denmark, UK and the US
Intervention: electromagnetic field treatment
Comparison: placebo

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Placebo

Electromagnetic field treatment

Pain
100 mm VAS

Scale from: 0 to 100

(Higher scores mean worse pain)
Follow‐up: mean 6 weeks

The mean change in pain in the control groups was 10.7

The mean change in pain in the intervention groups was
15.10lower
(9.08 to 21.13 lower)

434
(6 studies)

⊕⊕⊕⊝
moderate1

MD 15.10 (95% CI 9.08 to 21.13)

Absolute risk difference: 15% (95% CI 9.08% to 21.13%)

Relative per cent change: 21.03% (95% CI 12.65% to 29.43%)

NNT: 2 (95% CI 1 to 6)

Physical function

WOMAC function

Scale from: 0 to 100

(Higher scores mean more severe limitation)
Follow‐up: mean 3 months

The mean change in physical function in the control groups was
1.7

The mean change in physical function in the intervention groups was
4.55lower
(2.23 lower to 11.32 higher)

197
(3 studies)

⊕⊕⊝⊝
low2

MD 4.55 (95% CI ‐2.23 to 11.32)

Absolute risk difference: 4.55% (95% CI ‐2.23% to 11.32%)

Relative per cent change: 268% (95% CI ‐131% to 666%)

NNT: not statistically significant

Quality of life

SF‐36 item

Scale from: 0 to 100

(Lower scores mean worse quality)

Follow‐up: mean 16 weeks

The mean change in quality of life in the control groups was
2.4

The mean change in quality of life in the intervention groups was
0.09 lower
(0.36 lower to 0.54 higher)

145
(2 studies)

⊕⊕⊕⊝
moderate3

SMD 0.09 (95% CI ‐0.36 to 0.54)

Absolute risk difference: 1% (95% CI ‐2.92% to 4.37%)

Relative per cent change: 30.38% (95% CI ‐121.5% to 182.25%)

NNT: not statistically significant

Radiographic progression

Bone scintigraphic examinations

Follow‐up: mean 2.5 months

See comment

See comment

Not estimable

78
(1 study)

See comment

No related data were available

Number of patients experiencing any adverse event

Follow‐up: mean 1 month

167 per 1000

195 per 1000
(120 to 320)

RR 1.17
(0.72 to 1.92)

288
(4 studies)

⊕⊕⊕⊝
moderate4

Absolute risk difference: 3% (95% CI ‐6% to 12%)

Relative per cent change:

17% (95% CI ‐28% to 92%)

NNT: not statistically significant

Number of patients who withdrew because of adverse events

Follow‐up: mean 6 months

27 per 1000

24 per 1000

(2 to 376)

RR 0.90

(0.06 to 13.92)

78
(1 study)

⊕⊕⊝⊝
low5

Only 1 study: 1 participant withdrew from each group because of adverse skin reactions unrelated to the therapy

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; MD: mean difference; NNT: number needed to treat; RR: risk ratio; VAS: visual analogue scale;WOMAC: Western Ontario and McMaster Universities osteoarthritis index

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Downgraded for moderate heterogeneity (I2 = 55%); unclear risk for random sequence generation (Zizic 1995), allocation concealment (Zizic 1995), blinding of outcome assessors (Fary 2011; Nelson 2013; Zizic 1995), selective reporting (all six studies) and high risk for incomplete outcome data (Zizic 1995).
2Downgraded for considerable heterogeneity (I2 = 84%); Zizic 1995: unclear risk for random sequence generation, allocation concealment, blinding of outcome assessors, selective reporting and high risk for incomplete outcome data. Fary 2011: unclear risk for blinding of outcome assessors and selective reporting. Garland 2007: unclear risk for selective reporting.
3Fary 2011: unclear risk for blinding of outcome assessors and selective reporting. Pipitone 2001: high risk for incomplete outcome data.
4Unclear risk for random sequence generation (Thamsborg 2005; Zizic 1995), allocation concealment (Zizic 1995), blinding of outcome assessors (Thamsborg 2005; Zizic 1995), selective reporting (all four studies) and high risk for incomplete outcome data (Garland 2007; Thamsborg 2005; Zizic 1995).
5Only Zizic 1995 reported this outcome. Downgraded for imprecision (wide confidence interval and few events); unclear risk for random sequence generation, allocation concealment, blinding of outcome assessors and selective reporting and high risk for incomplete outcome data.

Figures and Tables -
Summary of findings for the main comparison. Electromagnetic field treatment compared to placebo for the treatment of osteoarthritis
Comparison 1. Electromagnetic fields versus placebo for osteoarthritis

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain Show forest plot

6

434

Mean Difference (IV, Random, 95% CI)

15.10 [9.08, 21.13]

2 Physical function Show forest plot

3

197

Mean Difference (IV, Random, 95% CI)

4.55 [‐2.23, 11.32]

3 Quality of life Show forest plot

2

139

Std. Mean Difference (IV, Random, 95% CI)

0.09 [‐0.36, 0.54]

4 Number of patients experiencing any adverse event Show forest plot

4

288

Risk Ratio (M‐H, Fixed, 95% CI)

1.17 [0.72, 1.92]

5 Number of patients who withdrew because of adverse events Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figures and Tables -
Comparison 1. Electromagnetic fields versus placebo for osteoarthritis