Short-term efficacy of physical interventions in osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled trials.

BACKGROUND: Treatment efficacy of physical agents in osteoarthritis of the knee (OAK) pain has been largely unknown, and this systematic review was aimed at assessing their short-term efficacies for pain relief. METHODS: Systematic review with meta-analysis of efficacy within 1-4 weeks and at follow up at 1-12 weeks after the end of treatment. RESULTS: 36 randomised placebo-controlled trials (RCTs) were identified with 2434 patients where 1391 patients received active treatment. 33 trials satisfied three or more out of five methodological criteria (Jadad scale). The patient sample had a mean age of 65.1 years and mean baseline pain of 62.9 mm on a 100 mm visual analogue scale (VAS). Within 4 weeks of the commencement of treatment manual acupuncture, static magnets and ultrasound therapies did not offer statistically significant short-term pain relief over placebo. Pulsed electromagnetic fields offered a small reduction in pain of 6.9 mm [95% CI: 2.2 to 11.6] (n = 487). Transcutaneous electrical nerve stimulation (TENS, including interferential currents), electro-acupuncture (EA) and low level laser therapy (LLLT) offered clinically relevant pain relieving effects of 18.8 mm [95% CI: 9.6 to 28.1] (n = 414), 21.9 mm [95% CI: 17.3 to 26.5] (n = 73) and 17.7 mm [95% CI: 8.1 to 27.3] (n = 343) on VAS respectively versus placebo control. In a subgroup analysis of trials with assumed optimal doses, short-term efficacy increased to 22.2 mm [95% CI: 18.1 to 26.3] for TENS, and 24.2 mm [95% CI: 17.3 to 31.3] for LLLT on VAS. Follow-up data up to 12 weeks were sparse, but positive effects seemed to persist for at least 4 weeks after the course of LLLT, EA and TENS treatment was stopped. CONCLUSION: TENS, EA and LLLT administered with optimal doses in an intensive 2-4 week treatment regimen, seem to offer clinically relevant short-term pain relief for OAK

Exercícios terapêuticos nas desordens temporomandibulares: uma revisão de literatura

A articulação temporomandibular faz parte do sistema estomatognático que, junto com os dentes, periodonto, coluna cervical, crânio e cintura escapular, é responsável pela mastigação, fonação, deglutição, respiração e expressão facial. Exercícios terapêuticos têm sido empregados na reabilitação e prevenção das disfunções temporomandibulares (DTM). Este estudo teve como objetivo revisar a literatura a respeito, verificando a eficácia dos exercícios terapêuticos nas DTM. Foram examinados periódicos do período entre 1991 e agosto de 2008, nas bases de dados Medline, Lilacs e Pubmed, utilizando as palavras-chave "desordem temporomandibular", "terapia por exercícios" e as correspondentes em inglês. Foram selecionados relatos de caso, artigos de revisão e ensaios clínicos com mais de 20 pacientes, num total de 53 artigos. A maioria relatou efeitos positivos na redução da dor, melhora da mobilidade e dos aspectos psicológicos, sugerindo que os exercícios podem contribuir no tratamento da DTM. Entretanto, o tipo, tempo de duração, número de repetições, freqüência e intensidade dos exercícios não está bem descrita. A falta de padronização das pesquisas, bem como da forma de avaliar, dificultam a comparação dos resultados. Mais estudos com métodos padronizados devem ser estimulados.The temporomandibular joint is part of the stomatognathic system, which comprises a complex set of orofacial structures, including teeth, cervical spine, cranium and shoulder. The system is responsible for masticatory, phonation, and deglutition functions, as well as for breathing and facial expression. Physical therapy exercises have been used for rehabilitation and prevention of temporomandibular disorders (TMD). The purpose of this study was to review studies on the subject and assess the effectiveness of physical therapy exercises for TMD. Case reports, review articles, and clinical trials with more than 20 patients, published from 1991 to mid-2008, were searched for in databases Medline, Lilacs and Pubmed, by using keywords "exercise therapy" "temporomandibular disorders", and the correspondent terms in Portuguese. Fifty-three studies were selected of which most showed positive effects on pain reduction, improvement in joint mobility and psychological aspects, suggesting that physical therapy exercises may be beneficial in TMD treating. However, the type, duration time, repetitions, frequency and intensity of the therapeutic exercises are not well described. The lack of research and assessment method standardization hinder result comparison. More studies with standardized methods must be stimulated