Soft Tissue Injuries |
| Treatment of Soft-tissue
Injuries
by Pulsed Electrical Energy (Diapulse) |
D.H. WILSON, F.R.C.S.,
Consultant Surgeon
Accident and Emergency Department, General Infirmary, Leeds
1
British Medical Journal, 1972, 2, 269—270 |
| Pulsed Electrical Energy |
| A 975-watt emission for 65 microseconds at
2712 megacycles with a resting interval between successive pulses
of 1,600 microseconds. Patients received continuous treatment
for one hour and were treated daily for three days. After each
treatment crepe bandages were applied from the toes to the calf
and the patients were given walking instruction and exercises
by an experienced physiotherapist. |
| Summary |
| Twenty pairs of patients matched for sex,
age, weight, and degree of trauma were treated either with an
active Diapulse machine emitting pulsed, high-frequency electrical
energy or with a non-active placebo machine. They were examined
for swelling, pain, and disability before treatment and after
three days under double-blind conditions. The results show that
the pulsed, high-frequency electrical treatment has a definite
biological effect on recently injured soft tissues, especially
in the reduction of pain and disability. |
| Introduction |
| The interrelation of mechanical stress and
electrical charges in collagen fibers has been examined in vitro
in both tendon and bone (Fukada and Yasuda, 1957, 1964; Bassett
and Becker, 1962; Bassett, 1965; Shamos and Levine, 1967) and
attempts have been made to use electrical energy to stimulate
the repair of collagen fibers in vivo (Ginsberg, 1961). Recently
J. M. Fitton and S. Hulman (personal communication, 1971) reported
favorably on a subjective trial of pulsed, high-frequency electrical
energy in the treatment of soft-tissue injuries. In view of
this a double-blind trial was planned to make a statistical
assessment of this treatment in patients suffering from a recent
sprain of the lateral ligaments of the ankle joint. |
| Patients and Method |
Patients who had sustained an inversion injury
of the ankle during the preceding 36 hours were examined physically
and radiologically to exclude a bony injury or a ligamentous
instability of the ankle. They were then graded for swelling,
pain, and disability and paired for age, weight, sex, and degree
of injury.
Diapulse machines were used to give the patients pulsed, high-frequency
electromagnetic radiation. These machines give |
| DETAILS OF DOUBLE-BLIND TRIAL |
| Six Diapulse machines were used, designated
by random letters from the alphabet and arranged in three pairs.
A fuse was removed from one of each pair of machines so as to
have one functional and one placebo machine in each pair. The
code indicating which machines were functional was placed in
a sealed envelope by the electrician and it was not opened until,
the trial had been completed. Patients receiving treatment from
a Diapulse machine are not aware of any sensation as there is
no heating of the tissues. Thus neither the patients nor the
clinician who examined them knew which patients had received
electrical treatment and which had the placebo. |
| GRADING OF PATIENTS’ SIGNS
AND SYMPTOMS |
Patients were examined before treatment on
the first day and after treatment on the third day, and on each
occasion were graded on a 0-4 scale for swelling, pain, and
disability (Table 1).
TABLE 1
Numerical, Grading of Signs and Symptoms
| Signs |
Grade Symptom |
| Swelling |
0
1
2
3
4 |
No increase of ankle circumference
compared
with uninjured ankle
Increased circumference of 0-1/2 in (1- 3 cm)
Increased circumference of -l in (13-25 cm)
Increased circumference of 1-11 in (25-38 cm)Increased
circumference of over I in (38 cm) |
| Pain |
0
1
2
3
4 |
No pain
Pain only after walking some distance
Pain on taking even one step
Pain when at rest on couch
Pain severe enough to require analgesics |
| Disability |
0
1
2
3
4 |
No disability
Walks with slight limp
Walks with considerable difficulty
Can walk only with help of supporting arm
Cannot walk at all |
ResultsThe scores of the 20 placebo patients (Table II) and
the 20 treated patients (Table III) in each of the measured
categories of swelling, pain, and disability were added together.
In each category the percentage improvement in the treated patients
was about twice that of the placebo patients.
TABLE
II - Total Grades of 20 Placebo Patients
| |
Swelling |
Pain |
Disability |
Total |
Before treatment
first day |
38 |
37 |
41 |
116 |
After treatment
third day |
26 |
25 |
23 |
74 |
| Percentage improvement |
31.6 |
74.4 |
75.6 |
756 |
TABLE III - Total Grades of 20 Treated Patients
| |
Swelling |
Pain |
Disability |
Total |
Before treatment
first day |
38 |
43 |
46 |
127 |
After treatment
third day |
14 |
11 |
6 |
31 |
| Percentage improvement |
63.2 |
74.4 |
86.9 |
75.6 |
|
| STATISTICAL ANALYSIS |
With a non-sequential method of analysis
the Diapulse treatment was found to be significantly preferable
to the placebo treatment on all four counts - that is, swelling,
disability, pain, and total scores.
A Bross plan B chart for sequential analysis of matched pairs
was used and Diapulse was found to be a preferable treatment
compared with placebo, statistically speaking, with respect
of improvement in disability scores, pain scores, and total
scores. No significant difference between the two groups was
found as regards improvement in swelling scores, although the
trend of results seen looked likely to produce a significant
result, given more results.
The outcome of awarding a positive sign when the treated patient’s
progress was better than his or her matched pair and a
TABLE IV - Results of Treatment in 20 Matched Pairs
of Patients
| |
# Positive |
# Negative |
P Value |
| Swelling |
9 |
2 |
.033 |
| Disability |
12 |
2 |
.006 |
| Pain |
13 |
2 |
.002 |
| Total Scores |
13 |
2 |
.011 |
negative sign when the placebo patient made more progress is
shown in Table IV. No sign was awarded when there was no clear
preference between the two patients. The P values in all four
categories are less than 0~O5. |
| Discussion |
This investigation shows that so far as sprained
ankles are concerned pulsed, high-frequency electrical treatment
has a biological effect on recently-injured soft tissues. This
is particularly noticeable in the reduction of pain and also
disability. The treatment is time consuming, however, both for
the patient and for the physiotherapist and it is probably not
justified in treating minor sprains where the patient can walk
on the ankle after the application of an adhesive bandage, but
for the patient who is more severely injured it has been shown
to be a valuable method of treatment.
I wish to express my thanks to the Principal and Governors of
Nonington College of Physical Education for making available
the services of Miss V. Barclay, who gave die physiotherapy
treatment.
The Diapulse machines were loaned by the Diapulse Corporation
of America.
The statistical analysis of the results was prepared through
the good offices of Messrs. Smith & Nephew Limited.
References
Bassett, C. A. L. (1965). Scientific American, 213, 18.
Bassett, C. A. L., and Becker, R.O. (1962). Science, 137, 1063.
Fukada, E., and Yasuda, I. (1957). Journal of the Physiological
Society of Japan, 12,1158.
Fukada, E., and Yasuda, I. (1964). Japanese Journal of Applied
Physics, 3, 117.
Ginsberg, A. J. (1961). International Record of Medicine, 174,
71.
Shamos, M. H., and Levine, L. 5. (1967). Nature, 213, 267. |
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