Electrotherapy for Neck Disorders (Review)

Purpose: Neck disorders are common, disabling and costly. The effectiveness of electrotherapy as a physiotherapy option has remained unclear. Objective of this systematic review is to assess whether electrotherapy, either alone or in combination with other treatments, relieves pain, or improves function/disability, patient satisfaction, and global perceived effect in adults with mechanical neck disorders (MND).

Methods: Search strategy:

Computer-assisted searches of bibliographic databases: CENTRAL, MEDLINE, EMBASE, MANTIS, CINAHL, and ICL, without language restrictions, from their beginning to March 2003.

Selection criteria:

Randomised or controlled clinical trials with quasi-randomisation (alternate allocation, case record numbers, dates of birth, etc.), in any language, investigating the effects of electrotherapy as a treatment for MND.

Data collection and analysis:

At least two authors independently conducted citation identification, study selection, data abstraction, and methodological quality assessment. Using a random-effects model, relative risk, and standardized mean differences were calculated. The reasonableness of

combining studies was assessed on clinical and statistical grounds. Due to heterogeneity, pooled effect measures were not calculated.

Results: Fourteen comparisons (525 people with MND), in 11 publications, were included in this review. The analysis was limited by underpowered low quality trials, paucity of literature, and heterogeneity of treatment subtypes. The results for the electrotherapy subtypes

are:

Limited evidence of benefit:

• low or high frequency pulsed electromagnetic field (PEMF) compared to placebo, provides immediate post treatment pain relief only for chronic MND, acute whiplash (WAD)

Unclear or conflicting evidence:

• direct and modulated Galvanic current compared to other treatments for pain in acute, subacute, chronic occipital headache

• iontophoresis compared to other treatments for pain, RTW, and self-assessment of overall outcome in acute, subacute WAD

• TENS compared to placebo for pain in acute WAD, chronic MND

• PEMF compared to placebo for medium or long term effect on pain, patient assessment of improvement, ADL in acute WAD, chronic MND

Discussion: We cannot make any definitive statements on the effects of electrotherapy for people with acute or chronic mechanical neck disorders (MND). Based on this review of 11 trials and 525 people with MND, the current evidence on Galvanic current (direct or pulsed), iontophoresis, TENS, EMS, PEMF and permanent magnets is either lacking, limited, or conflicting. This is mainly because of the paucity of trials, their low power, and the heterogeneity of methods. The few outcomes that reached statistical significance are of limited clinical importance.

References:

Kroeling P, Gross A, Goldsmith CH, Houghton PE, Cervical Overview Group. Electrotherapy for neck disorders. The Cochrane Database of Systematic Reviews 2005, Issue 2 (first published online 20 April 2005)