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demonstrated the role of calcium as a key element in the intracellular transduction of the signal produced by electromagnetic fields [24]. PEMFs are involved in the expression of genes that promote osteogenic cell differentiation and the production and mineralization of the extracellular matrix [25]. At the level of the cell membrane, PEMFs, being too weak, fail to generate membrane depolarization, but are involved in amplifying the trans- membrane signal by favoring the binding of the ligand to its receptor, triggering intra- cellular mechanisms involved in osteogenesis, cell proliferation and differentiation and immune modulation [26].
Randomized controlled studies in the literature concerning the efficacy of PEMFs in the treatment of osteoarthritis have shown conflicting results [27,28]. Markovic et al., in a systematic review of systematic reviews, showed that the use of PEMFs has a positive effect on disability and physical function of patients with osteoarthritis in only 5 out of 10 studies analyzed, while in 1 study, no statistically significant effect of PEMFs was reported [29]. This reflects the discordance in the literature concerning the use of PEMFs in the treatment of osteoarthritis. The variability in results could derive from the different durations of treatment with PEMFs in the various studies and the different frequency of weekly use, and also the application of different PEMF devices. The use of additional therapies for osteoarthritis at the same time as PEMFs may mask the efficacy of the latter.
1.6. Study Objectives
In this review, we analyzed various studies in the literature with the aim of assessing the effectiveness of PEMFs in the treatment of OA in different anatomical districts and their ability to improve patients’ quality of life by acting on various outcomes such as pain reduction.
2. Methods
Standard systematic review methods were used. The literature search was performed by three of the authors (GC, EDG and DC), independently of each other. This meta-analysis was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, ensuring a comprehensive and systematic approach to data retrieval and synthesis. This systematic review has been appropriately registered with the International Prospective Register of Systematic Reviews (PROSPERO) under registration number 524542.
Two electronic databases (PubMed and Google scholars) were searched for randomized controlled trials (RCTs) through using following the combination of a series of keywords and text terms: “arthritis”, “osteoarthritis”, “arthropathy”, “PEMF”, “Pulsed ElectroMag- netic Fields”. The exact search string used was ((arthritis[Title/Abstract]) OR (osteoarthri- tis[Title/Abstract]) OR (arthropathy[Title/Abstract])) AND ((PEMF[Title/Abstract]) OR (Pulsed ElectroMagnetic Fields[Title/Abstract])).
The literature references of identified papers were also searched in order to find further relevant articles. All journals were considered.
Our search strategy aimed to identify randomized controlled trials (RCTs) relevant to the therapeutic application of PEMFs in osteoarthritis. To minimize the number of missed studies, no time restrictions and no filters were applied to the search strategies. Article titles and abstracts were reviewed and the articles of interest were selected for the full text. The bibliography of the selected studies was accurately searched by hand to identify further studies not found during our electronic search. No restrictions on the date of publication or language were applied. After conducting a literature search, 100 papers were selected for further evaluation. Of these, 54 were excluded because the title or abstract did not meet the inclusion criteria. Of the remaining studies, through the analysis of the materials and methods, 29 were excluded because they were designed as experimental studies (in vitro studies, animal studies or cadaveric studies) or related to other inflammatory focuses (tendinitis, peri-implantitis). Ultimately, the 17 remaining papers met all of the criteria [Figure 1].
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