Using ultrasound elastography to assess non-invasive, non-pharmacological interventions for musculoskeletal stiffness: a systematic review and meta-analysis

Abstract

Purpose

To evaluate the current evidence regarding the use of ultrasound elastography for assessing non-invasive, non-pharmacological interventions for eliciting changes in musculoskeletal stiffness.

Methods

A systematic search of MEDLINE, CINAHL, EMBASE, and Web of Science databases was performed in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Information on measurement and intervention procedures was extracted. Bias was assessed using Cochrane Risk of Bias or Risk of Bias In Non-randomised Studies of Interventions (ROBINS-I) tools for studies with true or quasi-experimental designs, respectively. Analyses were conducted for adequately powered subgroups based on intervention type, measurement site, and population assessed.

Results

Twenty-one studies were included in the review. Overall risk of bias was low for true experimental studies and moderate for quasi-experimental studies. Subgroup analyses indicated a large overall effect for interventions involving manual physiotherapy and taping/splinting for reducing masseter muscle stiffness in patients with masticatory muscle disorders (g = 1.488, 95% CI = 0.320–2.655, p = 0.013). Analyses for other intervention types and patient groups were underpowered.

Conclusion

Ultrasound elastography demonstrates clinical applicability for assessing non-invasive, non-pharmacological interventions for musculoskeletal stiffness. However, the comparative efficacy of these interventions for modulating tissue stiffness remains inconclusive.

IMPLICATIONS FOR REHABILITATION

• Elastography demonstrates clinical applicability for assessing non-invasive, non-pharmacological interventions for musculoskeletal stiffness

• Interventions involving manual physiotherapy and taping/bracing showed a large overall effect for reducing masseter muscle stiffness

• The comparative efficacy of other interventions remains inconclusive

Keywords:

• Ultrasonography
• elasticity imaging techniques
• musculoskeletal system
• conservative treatment
• physical therapy modalities

Disclosure statement

No potential conflict of interest was reported by the author(s).

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Data availability statement

Not applicable to this review.

Additional information

Funding

No direct funding was provided for this review. Tiev Miller, Umar M. Bello, and Charlotte S.L. Tsang were supported by general research studentships provided by the Hong Kong Polytechnic University through the Department of Rehabilitation Sciences (funding codes RL27, RL23, RUNV).