Physical Agents & Electrotherapeutic Modalities
We are unable to recommend for or against the use of physical agents (including electrotherapeutic modalities) in patients with symptomatic osteoarthritis of the knee.

Rationale
The evidence was mixed regarding the efficacy of physical agents and electrotherapeutic modalities because of contradiction in findings, design flaws, or a low count of like studies. A single low-strength70 and a single-moderate strength study71 comparing pulsed electrical stimulation to placebo produced contradictory results. See the results of the Fary et al.70 and Zizic et al.71 articles in table 96. Trock et al.72 conducted a moderate-strength study evaluating pulsed electromagnetic stimulation and found that it did not generate a statistically significant effect on pain during passive motion, but that tenderness and physician’s overall assessment scores were superior in the experimental group. Atamaz et al.73 conducted a moderate-strength study that compared transcutaneous electrical nerve stimulation (TENS), shortwave diathermy, and interferential current to a sham procedure. None of the treatments were associated with statistically significant effects on pain, physical mobility, or ambulation time at four, 12, or 26 weeks. Battisti et al.,74 also in a moderate-strength study, found that therapeutic application of modulated electromagnetic field therapy (TAMMEF) did not produce statistically significant improvements in pain or Lequesne Index scores, compared to extremely low-frequency electromagnetic field therapy.
However, there was evidence that ultrasound was effective in patients with knee osteoarthritis. Huang et al.75 and Yang et al.76 conducted moderate-strength studies that compared ultrasound to a control group. Huang et al. found that patients who received isotonic exercise with ultrasound had significantly superior ambulation speed, Lequesne Index scores, and VAS pain scores. Yang et al. found VAS pain and Lequesne Index scores were significantly superior at 4 weeks in patients who received ultrasound over those who received a sham treatment.
Due to the overall inconsistent findings for various physical agents and electrotherapeutic modalities, we were unable to make a recommendation for or against their use in patients with symptomatic osteoarthritis of the knee.

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