Extended report
No effect of bipolar interferential electrotherapy and pulsed
ultrasound for soft tissue shoulder disorders: a randomised controlled
trial
Geert J M G van der Heijdena b, Pieter Leffersb c, Pieter J M C Woltersd, José J D Verheijden, Henk van Mamerenb e, Jo P Houbend, Lex M Bouterb f, Paul G Knipschildb c
a Institute
for Rehabilitation Research, Hoensbroek, the Netherlands, b Netherlands School of Primary
Care Research, c Department of Epidemiology, University
Maastricht, the Netherlands, d Hogeschool
Limburg, Faculty of Health, School for Physiotherapy, Heerlen, the
Netherlands, e Department of Anatomy and Embryology, University
Maastricht, the Netherlands, f Institute for Research in Extramural medicine,
Vrije Universiteit, Amsterdam, the Netherlands
Correspondence to: Dr G J M G van der Heijden, iRv, Institute for Rehabilitation Research, PO Box 192, 6430 AD Hoensbroek, the Netherlands.
Accepted for publication 22 March 1999
OBJECTIVE
To assess
the efficacy of bipolar interferential electrotherapy (ET) and pulsed
ultrasound (US) as adjuvants to exercise therapy for soft tissue
shoulder disorders (SD).
METHODSRandomised
placebo controlled trial with a two by two factorial design plus an
additional control group in 17 primary care physiotherapy practices in
the south of the Netherlands. Patients with shoulder pain and/or
restricted shoulder mobility, because of a soft tissue impairment
without underlying specific or generalised condition, were enrolled if
they had not recovered after six sessions of exercise therapy in two
weeks. They were randomised to receive (1) active ET plus active US;
(2) active ET plus dummy US; (3) dummy ET plus active US; (4) dummy ET
plus dummy US; or (5) no adjuvants. Additionally, they received a
maximum of 12 sessions of exercise therapy in six weeks. Measurements
at baseline, 6 weeks and 3, 6, 9, and 12 months later were blinded for
treatment. Outcome measures: recovery, functional status, chief
complaint, pain, clinical status, and range of motion.
RESULTSAfter written
informed consent 180 patients were randomised: both the active
treatments were given to 73 patients, both the dummy treatments to 72 patients, and 35 patients received no adjuvants. Prognosis of groups
appeared similar at baseline. Blinding was successfully maintained. At
six weeks seven patients (20%) without adjuvants reported very large
improvement (including complete recovery), 17 (23%) and 16 (22%) with
active and dummy ET, and 19 (26%) and 14 (19%) with active and dummy
US. These proportions increased to about 40% at three months, but
remained virtually stable thereafter. Up to 12 months follow up the
95% CI for differences between groups for all outcomes include zero.
CONCLUSIONNeither ET
nor US prove to be effective as adjuvants to exercise therapy for soft
tissue SD.
© 1999 by Annals of the Rheumatic Diseases
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