Effectiveness of ultrasound therapy for myofascial pain syndrome: a systematic review and meta-analysis

Figures & data

Figure 1 Flowchart of study selection

Abbreviation: US, ultrasound.

Table 1 Characteristics of included studies

Reference	Groups	Balance*	n†	Age (years)	Sex(M/F)	BMI (kg/m^2)	Parameters of intervention	Outcomes	Test time#	Risk of bias
Kavadar et al (20I5)^Citation25	Gl: CUS G2: sham	NR	30 29	37.43 35.83	6/24 4/25	23.9 25.2	I.5 W/cm^2,I MHz, 6 min, 15 sessions	VAS (rest, activity), PPT, 0–5 scale, BDS	0, 3 months	Low
Ilter et al (20I5)^Citation24	G1: CUS G2: PUS G3: sham	Exercise	20 20 20	33 32 33	8/12 4/16 6/14	NR	1 W/cm^2, 3 MHz, 5 min, 10 sessions (within 2 weeks)	VAS (rest, activity), five-step scale, BDS, NHP, NPDS	0, 6, 12 weeks	Low
Manca et al (20I4)^Citation23	G1: CUS G2: sham	NR	12 12	24.5 26	5/7 6/6	NR	1.5 W/cm^2, 3 MHz, 12 min, 10 sessions (within 2 weeks)	NRS, PPT, cervical joint ROM	0, 12 weeks	Low
Sarrafzadeh et al (20I2)^Citation22	G1: PUS G2: blank	NR	15 15	21.47 22.2	Only females	20.5 20.4	1.2 W/cm^2, 1 MHz, 5 min, six sessions	VAS, PPT, cervical joint ROM	0 week	Unclear
Ay et al (20II)^Citation21	G1: US (unclear mode) G2: sham	Exercise	20 20	48.8 49.45	5/15 4/16	NR	1.5 W/cm^2, 1 MHz, 10 min, 15 sessions (within 3 weeks)	VAS, PPT, NPDS, cervical joint ROM, numbers of trigger points	0 week	Unclear
Dündar et al (2010)^Citation11	G1: CUS G2: sham	Exercise	28 27	36.6 35.8	8/20 8/I9	NR	1.5 W/cm^2, 1 MHz, 8 min, 15 sessions (within 3 weeks)	VAS (rest, activity), cervical joint ROM, NDl, NHP	0, 12 weeks	Unclear
Aguilera et al (2009)^Citation20	G1: PUS G2: sham	NR	22 22	39 34.7	10/12 10/12	NR	1 W/cm^2, 1 MHz, 2 min	PPT, cervical joint ROM, BEA	0 week	High
Srbely et al (2008)^Citation19	Gl: US (unclear mode) G2: sham	NR	25 25	42.9 48.6	10/15 13/12	26.4 23.5	0.52 W/cm^2, I MHz, I0 min	PPT	1, 3, 5, 10, 15 min	Unclear
Gam et al (I998)^Citation12	G1: PUS G2: sham	Exercise	18 22	39.5 42	NR	NR	3 W/cm^2, 100 Hz, 15 min, eight sessions (within 4 weeks)	VAS (rest, activity), numbers of trigger points	0, 6 weeks	High
Lee et al (1997)^Citation13	G1: US (unclear mode) G2: sham	NR	26$	43.7$	12/14$	NR	0.5 W/cm^2, 6 min	VAS, PPT, cervical joint ROM	0 week	High

Notes:

* All patients accepted usual care, which was balanced between groups.

# 0 means at the end of the treatment.

$ Only data from the whole trial are available.

† n = number of patients. Age and BMI data are shown as mean.

Abbreviations: BDS, Beck’s depression scale; BEA, basal electrical activity; BMI, body mass index; CUS, continuous ultrasound; F, female; G, group; M, male; NDI, neck disability index; NHP, Nottingham health profile; NPDS, neck pain and disability scale; NR, not reported; NRS, numerical rating scale; PPT, pressure pain threshold; PUS, pulsed ultrasound; ROM, range of motion; US, ultrasound; VAS, visual analog scale.

Figure 2 Risk of bias assessment.

Notes: (A) Risk of bias graph: review authors’ judgments about each risk of bias item presented as percentages across all included studies. (B) Risk of bias graph: review authors’ judgments about each risk of bias item for each included study.

Figure 3 Meta-analyses of US therapy on pain intensity (VAS or NRS).

Notes: (A) SMDs of at rest and activity. (B) SMDs at 0 and 12 weeks. (C) SMDs at rest after excluding two studies.
Abbreviations: CI, confidence interval; IV, inverse variance; NRS, numerical rating scale; SD, standard deviation; SMD, standardized mean difference; US, ultrasound; VAS, visual analog scale.

Figure 4 Meta-analyses of US therapy on pain threshold (PPT).

Notes: (A) SMDs at 0 and 12 weeks. (B) SMDs at 0 week after excluding two studies.
Abbreviations: CI, confidence interval; IV, inverse variance; PPT, pressure pain threshold; SD, standard deviation; SMD, standardized mean difference; US, ultrasound.

Figure 5 Meta-analyses of US therapy on cervical joint ROM at the last follow-up time.

Notes: (A) SMDs at lateral flexion, rotation, flexion, or extension. (B) SMDs at lateral flexion after excluding one study.
Abbreviations: CI, confidence interval; IV, inverse variance; ROM, range of motion; SD, standard deviation; SMD, standardized mean difference; US, ultrasound.

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