Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Osteoarthritis - Evidence
Evidence on electrotherapy (ultrasound, laser, TENS, PEMF)

Ultrasound: there is evidence from three RCTs that ultrasound has no benefit in the treatment of knee and hip osteoarthritis.

Laser therapy: there is evidence from nine RCTs that laser therapy has no benefit in the treatment of osteoarthritis (multiple joints).

Transcutaneous electrical nerve stimulation (TENS, AL-TENS, interferential therapy): there is mixed, but mostly positive evidence from 10 RCTs that TENS may relieve the pain and stiffness of knee osteoarthritis, especially in the short term. There is no evidence that efficacy tails off over time, nor that periodic use for exacerbations is helpful.

Pulsed electromagnetic field (PEMF): there is limited evidence from systematic reviews of RCTs that PEMF may relieve pain and improve function in people with knee osteoarthritis. There is no evidence on the effects of PEMF on osteoarthritis in other joints.

The National Institute for Health and Clinical Excellence (NICE) conducted a systematic review of the effects of electrotherapy: ultrasound; laser; TENS, TNS, AL-TENS, and interferential therapy; and pulsed shortwave diathermy (PEMF) on osteoarthritis [National Collaborating Centre for Chronic Conditions, 2008]. Five systematic reviews and meta-analyses were found on electrotherapy (laser, electromagnetic fields, ultrasound, and TENS) and six additional RCTs on laser, electromagnetic fields, and TENS.

  • Ultrasound:
    • One systematic review/meta-analysis of three RCTs was found on the use of ultrasound for people with knee or hip osteoarthritis.
    • Pain, function/disability, and global assessment: no significant benefits.
  • Laser:
    • One systematic review/meta-analysis of seven RCTs, and two further RCTs were found on the use of laser therapy in people with osteoarthritis.
    • Pain: one of three comparisons favoured laser therapy, but the clinical importance is unclear.
    • Stiffness, function, global assessment, quality of life: no significant benefits.
  • TENS, including AL-TENS and interferential therapy:
    • One systematic review/meta-analysis of seven RCTs, and three further RCTs, were found on the use of TENS in people with osteoarthritis.
    • Pain, stiffness, function/disability, quality of life: mixed results from different measures of pain, some favouring TENS/AL-TENS, some not significant, and a few favouring the comparator.
  • PEMF:
    • Two systematic reviews/meta-analyses (reviewing six RCTs, and five RCTs respectively) were found on the use of PEMF in people with knee osteoarthritis.
    • Pain: significant benefits for three of four measures of pain.
    • Stiffness: no significant benefits.
    • Function/disability: significant benefits for three of four measures of function/disability.
    • Global assessment: significant benefits of physician's global assessment, but not for patient's global assessment.
    • Quality of life: significant benefits for two of three measures of quality of life.

© NHS Institute for Innovation and Improvement