title: The efficacy, safety, effectiveness, and cost-effectiveness of ultrasound and shock wave therapies for low back pain: a systematic review.
abstract: BACKGROUND
  Shock wave and especially ultrasound are commonly used to treat low back pain (LBP) in routine practice.
  
  
  OBJECTIVE
  To assess the evidence on the efficacy, effectiveness, cost-effectiveness, and safety of ultrasound and shock wave to treat LBP.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  An electronic search was performed in MEDLINE, EMBASE, and the Cochrane Library databases up to July 2009 to identify randomized controlled trials (RCTs) comparing vibrotherapy with placebo or with other treatments for LBP. No language restrictions were applied. Additional data were requested from the authors of the original studies. The risk of bias of each study was assessed following the criteria recommended by the Cochrane Back Review Group.
  
  
  RESULTS
  Thirteen studies were identified. The four RCTs complying with the inclusion criteria included 252 patients. Two of the three RCTs on ultrasound had a high risk of bias. For acute patients with LBP and leg pain attributed to disc herniation, ultrasound, traction, and low-power laser obtained similar results. For chronic LBP patients without leg pain, ultrasound was less effective than spinal manipulation, whereas a shock wave device and transcutaneous electrical nerve stimulation led to similar results. Results from the only study comparing ultrasound versus a sham procedure are unreliable because of the inappropriateness of the sham procedure, low sample size, and lack of adjustment for potential confounders. No study assessed cost-effectiveness. No adverse events were reported.
  
  
  CONCLUSIONS
  The available evidence does not support the effectiveness of ultrasound or shock wave for treating LBP. High-quality RCTs are needed to assess their efficacy versus appropriate sham procedures, and their effectiveness and cost-effectiveness versus other procedures shown to be effective for LBP. In the absence of such evidence, the clinical use of these forms of treatment is not justified and should be discouraged.
authors.affiliation: Department of Nursing and Physical Therapy, Institute of Biomedicine, University of León, Ponferrada, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Seco
authors.forename: Francisco M
authors.initials: FM
authors.lastname: Kovacs
authors.forename: Gerard
authors.initials: G
authors.lastname: Urrutia
mesh_terms: D003362:Cost-Benefit Analysis; D019220:High-Energy Shock Waves / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D017116:Low Back Pain / Q000191:economics / Q000628:therapy*; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000009:adverse effects* / Q000191:economics / Q000379:methods