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Therapeutic ultrasound for acute ankle sprains
M P J van den Bekerom1, D A W M van der Windt, G Ter Riet
1Department of Orthopedic Surgery, Spaarne Hospital, Hoofddorp, The Netherlands. bekerom@gmail.com
Background:
Ultrasound is used in the treatment of a wide variety of musculoskeletal disorders, which include acute ankle sprains.
Aim:
To evaluate the effects of ultrasound therapy in the treatment of acute ankle sprains.
Methods:
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE until September 2010, CINAHL (until 2004), and PEDro (accessed 01/06/09). (Quasi)-randomised trials were included if the following conditions were met: at least one study group was treated with therapeutic ultrasound; participants had acute lateral ankle sprains; and outcome measures included general improvement, pain, swelling, functional disability, or range of motion. Risk ratios and risk differences with 95% confidence intervals were calculated for dichotomous outcomes and mean differences with 95% confidence intervals for continuous outcome measures. Limited pooling of data was undertaken where there was clinical homogeneity in terms of participants, treatments, outcomes, and follow-up time points.
Results:
Six trials were included, involving 606 participants. Five trials included comparisons of ultrasound therapy with sham ultrasound; and three trials included single comparisons of ultrasound with three other treatments. None of the five placebo-controlled trials (sham ultrasound) demonstrated differences between true and sham ultrasound therapy for any outcome measure at one to four weeks of follow-up. The pooled risk ratio for general improvement at one week was 1.04 (random-effects model, 95% confidence interval 0.92 to 1.17) for active versus sham ultrasound. The differences between intervention groups were generally small, between 0% and 6%, for most dichotomous outcomes.
Conclusion:
The evidence from the five small placebo-controlled trials included in this review does not support the use of ultrasound in the treatment of acute ankle sprains. The potential treatment effects of ultrasound appear to be generally small and probably of limited clinical importance, especially in the context of the short-term recovery period in most people with these injuries. However, the available evidence is insufficient to rule out the possibility that there is an optimal dosage schedule for ultrasound therapy that may be of benefit.
