Page | 006 with whole-body mats. Consistent with the current results, a pilot trial demonstrated no positive impact of monopolar transmission of PEMF therapy on depression or QOL in patients with MS.30 In contrast, low-frequency PEMF was superior to placebo to evoke long-term positive changes on depression in this population.22 In women with fibromyalgia, this treatment has shown to improve health-related QOL, with no beneficial effects for depression.44 This inconclusive evidence also applies to other musculoskeletal and neuro- logical conditions.12,45
Adverse effects
PEMF therapy is a non-invasive and purportedly safe tech- nique,40 although little is known about the potential long- term hazards.11 As in previous research,21,32 our participants did not report acute or minor adverse events. Current rec- ommendations suggest that magnetic field treatment should be used cautiously, with supervision, and only when recom- mended, because some commercially-available products may not comply with safety guidelines.46
Study limitations
We did not include participants with severe disability or in need of a walking aid (EDSS > 4.5).19 Although this was intended to recruit an homogenous sample, it may also limit the external validity of the findings. Patients with MS show differences in inflammatory factors depending on disease activity and type, thus the antiinflammatory effect of PEMF therapy may differ at different stages of the disease. This needs to be investigated in further research that also includes a longer follow-up. Finally, the possible mediating effect of comorbidities was not investigated.
Conclusion
The study concluded that, in adults with RRMS and with min- imal to significant level of disability, the use of low fre- quency PEMF therapy was not better than placebo to improve the level of fatigue, walking performance, severity of depression, and QOL.
Trial registered
ACTRN12618000515291 (https://anzctr.org.au/Trial/Regis tration/TrialReview.aspx?id=373996&isReview=true)
Conflicts of interest
The authors declare no conflict of interest.
Acknowledgements
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sec- tors.
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