What is the landscape of evidence about the safety of physical agents used in physical medicine and rehabilitation? A scoping review.
adverse events
health & safety
rehabilitation medicine
Journal
BMJ open
ISSN: 2044-6055
Titre abrégé: BMJ Open
Pays: England
ID NLM: 101552874
Informations de publication
Date de publication:
23 06 2023
23 06 2023
Historique:
medline:
26
6
2023
pubmed:
25
6
2023
entrez:
24
6
2023
Statut:
epublish
Résumé
Several systematic reviews (SRs) assessing the effectiveness of superficial physical agents have been published, but the evidence about their safety remains controversial. To identify areas where there is evidence of the safety of physical agents by a scoping review. Four databases were systematically searched for including English SRs that explored and reported safety in terms of adverse events (AEs) related to the application of physical agents in outpatient and inpatient physical medicine and rehabilitation settings managed by healthcare professionals, published in January 2011-29 September 2021. The severity of AEs was classified according to the Common Terminology Criteria. Then, AE findings were summarised according to the SR syntheses. Finally, the reporting of the certainty of the evidence was mapped. Overall, 117 SRs were retrieved. Most of the SRs included randomised controlled trials (77%) and patients with musculoskeletal disorders (67%). The most investigated physical agents were extracorporeal shock wave therapy (ESWT) (15%), transcutaneous electrical nerve stimulation (13%) and electrical stimulation (12%). No AE (35%) was reported in one-third of the included primary studies in SRs, whereas few severe AEs occurred in less than 1% of the sample. Among physical agents, ESWT showed an increased risk of experiencing mild AEs compared with the control. Most SRs reported a qualitative AE synthesis (65.8%), and few reported the certainty of the evidence (17.9%), which was mainly low. We found evidence of safety on several physical agents coming mostly from qualitative synthesis. No significant harms of these interventions were found except for ESWT reporting mild AEs. More attention to the AEs reporting and their classification should be pursued to analyse them and assess the certainty of evidence quantitatively. https://osf.io/6vx5a/.
Sections du résumé
BACKGROUND
Several systematic reviews (SRs) assessing the effectiveness of superficial physical agents have been published, but the evidence about their safety remains controversial.
OBJECTIVE
To identify areas where there is evidence of the safety of physical agents by a scoping review.
DESIGN
Four databases were systematically searched for including English SRs that explored and reported safety in terms of adverse events (AEs) related to the application of physical agents in outpatient and inpatient physical medicine and rehabilitation settings managed by healthcare professionals, published in January 2011-29 September 2021. The severity of AEs was classified according to the Common Terminology Criteria. Then, AE findings were summarised according to the SR syntheses. Finally, the reporting of the certainty of the evidence was mapped.
RESULTS
Overall, 117 SRs were retrieved. Most of the SRs included randomised controlled trials (77%) and patients with musculoskeletal disorders (67%). The most investigated physical agents were extracorporeal shock wave therapy (ESWT) (15%), transcutaneous electrical nerve stimulation (13%) and electrical stimulation (12%). No AE (35%) was reported in one-third of the included primary studies in SRs, whereas few severe AEs occurred in less than 1% of the sample. Among physical agents, ESWT showed an increased risk of experiencing mild AEs compared with the control. Most SRs reported a qualitative AE synthesis (65.8%), and few reported the certainty of the evidence (17.9%), which was mainly low.
CONCLUSION
We found evidence of safety on several physical agents coming mostly from qualitative synthesis. No significant harms of these interventions were found except for ESWT reporting mild AEs. More attention to the AEs reporting and their classification should be pursued to analyse them and assess the certainty of evidence quantitatively.
REVIEW REGISTRATION
https://osf.io/6vx5a/.
Identifiants
pubmed: 37355261
pii: bmjopen-2022-068134
doi: 10.1136/bmjopen-2022-068134
pmc: PMC10314460
doi:
Types de publication
Systematic Review
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e068134Investigateurs
Anna Fulvio
(A)
Serena Barsaglini
(S)
Vincenzo Genovese
(V)
Matteo Benedini
(M)
Emanuele Proverbio
(E)
Simone Cecchetto
(S)
Informations de copyright
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Cochrane Database Syst Rev. 2013 Aug 26;(8):CD004251
pubmed: 23979926
Medicine (Baltimore). 2018 Dec;97(50):e13687
pubmed: 30558080
Cochrane Database Syst Rev. 2017 Dec 12;12:CD011289
pubmed: 29231243
BMJ. 2017 Sep 21;358:j4008
pubmed: 28935701
Cochrane Database Syst Rev. 2020 Mar 4;3:CD008962
pubmed: 32128761
Am J Phys Med Rehabil. 2013 Jul;92(7):606-20
pubmed: 23552334
Ann Intern Med. 2018 Oct 2;169(7):467-473
pubmed: 30178033
Arch Phys Med Rehabil. 2021 Feb;102(2):340-342
pubmed: 33334548
J Clin Epidemiol. 2022 Nov;151:104-112
pubmed: 35987405
BMJ. 2016 Feb 01;352:i157
pubmed: 26830668
Physiother Can. 2010 Fall;62(5):1-80
pubmed: 21886384
Cochrane Database Syst Rev. 2017 Sep 14;9:CD011976
pubmed: 28905362
Cochrane Database Syst Rev. 2014 Oct 01;(10):CD011324
pubmed: 25271097
PLoS Med. 2016 Sep 20;13(9):e1002127
pubmed: 27649528
EFORT Open Rev. 2020 Oct 26;5(10):584-592
pubmed: 33204500
BMJ. 1996 Jan 13;312(7023):71-2
pubmed: 8555924
BMJ. 2008 Apr 26;336(7650):924-6
pubmed: 18436948
Ann Intern Med. 2004 Nov 16;141(10):781-8
pubmed: 15545678
J Orthop Sports Phys Ther. 2010 Aug;40(8):455-63
pubmed: 20710083
Phys Ther Sport. 2014 Nov;15(4):261-8
pubmed: 24713365
J Clin Epidemiol. 2011 Dec;64(12):1283-93
pubmed: 21839614
BMJ. 2008 May 3;336(7651):995-8
pubmed: 18456631
Sci Transl Med. 2014 Feb 19;6(224):224cm1
pubmed: 24553383
J Clin Epidemiol. 2011 Apr;64(4):383-94
pubmed: 21195583