Arch Phys Med Rehabil. 2003 Sep; 84(9): E25.

Efficacy of physical medicine modalities in the treatment of neuromusculoskeletal pain: A review of literature. Susan K. Mihans, PT (National Institutes of Health, Silver Spring, MD); Jay P. Shah, MD; Jill Gleason, PT; Jerome V. Danoff, PhD, e-mail: smihans@mail.cc.nih.gov.

OBJECTIVE: To review the current literature on efficacy of physical medicine modalities on neuromusculoskeletal pain. Data Sources: PubMed, CINAHL, and Web of Science were searched from January 1997 to June 2002 for articles in English reporting the efficacy of physical medicine modalities (eg, acupuncture, manipulation) for neuromusculoskeletal pain. Data Extraction: Articles were categorized by type of evidence from I to V according to Sackett's rules of evidence. Strength of evidence was graded on agreement among articles for a particular modality. 9 specific criteria to assess research design quality (eg, randomized, controlled, blinded) and an 11-item subject profile (eg, physical exam, imaging studies, structural diagnosis) were developed. Documentation of these criteria and items is critical for evaluating research methodology, determining subject characteristics, and comparing studies of modality efficacy by applying the subject profile and specific criteria. These were assessed only in types II, III, and IV studies (50 articles) because only these articles had an experimental design and a subject population. Data Synthesis: There was little interarticle agreement among the 83 articles reviewed on the efficacy of treatment for each modality. For research design quality; type II studies averaged 78%; type III studies, 44%; and type IV studies, 22%. For subject profile; type II, type III, and type IV studies contained less than half of the 11 critical items. Conclusions: Analysis of data collected failed to support strong interarticle agreement. Studies reviewed were inconsistent in methodology and design necessary to establish efficacy or association. Future studies should include more stringent research methods and better description of subject characteristics.