Analysis of Human Tissue Temperature After Application of Therapeutic Modalities.

Coplanar Arrangement of Shortwave Diathermy is the Most Efficient in Skin Temperature Change: A Randomized Crossover Trial

Attempting an effective treatment is essential to the physiotherapist to understand how his conducts affect body tissues and the whole system, besides understand properly how and when therapeutic modalities could be use in the rehabilitation process. There are several research articles pointing the use of heat as an efficient agent to accelerate tissue healing. Clarifying the remaining doubts related to therapeutic modalities use can be beneficial for functional rehabilitation.

In physiotherapy, shortwave diathermy is one of the standards treatments for heat inducement. The capacitance shortwave technique consists in the use of two pad electrodes that can be positioned in three different arrangements: coplanar (placed side by side on the same aspect of the part to be treated), contraplanar (placed over opposite aspects of the body part to be treated) and longitudinal (one electrode is placed at each end of the limb in opposite aspects of the body par to be treated). There is no evidence of which arrangement is the most efficient.

Besides shortwave diathermy being a very established therapeutic modality, the use of this recourse in the most effective way rely on the properly answer of the remaining questions related to its application. Therefore, the purpose of this study is to analyze which one of the capacitance shortwave technique is the most efficient in inducing and maintaining heat.

Given the high-frequency waves field orientation could be suggested that the coplanar arrangement will lead to bigger heat inducement, and will maintain it for longer time.

Study Overview

• Status: Completed
• Conditions: Young Adult; Health; Humans
• Intervention / Treatment: Other: Coplanar; Other: Contraplanar; Other: Longitudinal

Detailed Description

The data for the sample size calculation was taken from a pilot study of 8 subjects. The software used to calculate the sample was GPower 3.1.9.2. A 18 subjects sample were obtained to reach a power of 90%, needed to detect a difference on the average of the groups in repeated measures with an alpha of 5%. The sample size was raised to 20 subjects for eventually lost. The subjects will be chosen through social media and informal invitations.

The subjects will attend to the laboratory four times, the first day for orientation and measurements (body mass and skinfold), the data collection will start on the second day.

The room temperature will be set between 23 °C and 25 °C, and the humidity around 70%. The subject will be placed in supine position on the stretcher, instructed to relax and not touch the right thigh region for 20 minutes before the intervention (for body temperature stabilization).

The thigh size will be measured form the base of the patella to the anterior superior iliac spine and the center marked to determine the place where the temperature will be collected. The minimum space between electrodes position will be at least of the size of one electrode. The temperature of the right thigh will be measured by infrared thermography before the intervention, right after the removal and every minute until the total time of the intervention.

To summarize the data, it will be used descriptive statistics, the values of average, standard deviation and the collected measurements will be identified. Through Shapiro-Wilk test the distribution of data regarding normality will be verified. To compare the initial and the final test values the ANOVA and the post-hoc of Bonferroni will be used. In the case of data being out of the normal standards, a transformation will be used to reach the normality. If the data still don't reach the normality after the transformation, the non-parametric tests will be used (Mann-Whitney e Kruskal Walis). The confidence level adopted for all tests will be 95% (p <0.05).

• Study Type: Interventional
• Enrollment (Actual): 20
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Brazil
  • SC
    • Araranguá, SC, Brazil, 88.906-072
      • Santa Catarina Federal University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 19 years to 40 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Male

Description

Inclusion Criteria:

• No orthopedic injury in three months prior to the study;
• A minimum of 19 years of age, and a maximum of 40 years;
• Male;
• Must agree not to practice exercise the day before the study and not ingest caffeine, alcohol, or food one hour before intervention.

Exclusion Criteria:

• Skinfold minor than 2cm;
• Circulatory system disease;
• Ischemic tissue or malignant tumors;
• External fixation, metal or pacemaker;
• Any thigh open wound;
• Muscular or neurological disease;
• Diabetes diagnosed;
• Cigarette smoker.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Coplanar; Electrode placed side by side on the same aspect of the right tight.	Other: Coplanar; The coplanar arrangement will be applicated in each one of the subjects. The intervention will last 20 minutes. A towel will be placed between the pad electrode and the skin to improve contact, besides, the tight and the electrode will be wrapped with an elastic band for the same purpose. The subject will receive orientation related to the heat intensity, it must be a comfortable perception of heat (the intensity will be regulated on the equipment to guarantee that).
Active Comparator: Contraplanar; Electrode placed over opposite aspects of the right tight.	Other: Contraplanar; The contraplanar arrangement will be applicated in each one of the subjects. The intervention will last 20 minutes. A towel will be placed between the pad electrode and the skin to improve contact, besides, the tight and the electrode will be wrapped with an elastic band for the same purpose. The subject will receive orientation related to the heat intensity, it must be a comfortable perception of heat (the intensity will be regulated on the equipment to guarantee that).
Active Comparator: Longitudinal; One electrode is placed at each end of the limb in opposite aspects of the tight.	Other: Longitudinal; The longitudinal arrangement will be applicated in each one of the subjects. The intervention will last 20 minutes. A towel will be placed between the pad electrode and the skin to improve contact, besides, the tight and the electrode will be wrapped with an elastic band for the same purpose. The subject will receive orientation related to the heat intensity, it must be a comfortable perception of heat (the intensity will be regulated on the equipment to guarantee that).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The Most Effective Capacitance Shortwave Technique in Relation to Temperature Increase and Heat Conservation Measured by Infrared Thermography	Evaluation of the most effective electrode arrangement (coplanar, contraplanar or longitudinal) in relation to temperature increase and heat conservation. Measured using a infrared camera in three sessions, with a washout period of at least 24 hours.	3 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Temperature Increase	Determine which capacitance shortwave technique will increase the temperature the most after 20 minutes of application. The skin temperature will be verified by infrared thermography. This evaluation will occur in three 24 hours apart visits, each for one of the three capacitance shortwave technique.	3 days
Heat Conservation	Determinate which capacitance shortwave technique retain the induced heat for longer time. The skin temperature will be verified by infrared thermography before the application and after during 25 minutes, 1 minutes apart each measure. This evaluation will occur in three 24 hours apart visits, each for one of the three capacitance shortwave technique.	3 days

Collaborators and Investigators

• Sponsor: Alessandro Haupenthal
• Collaborators: Santa Catarina Federal University
• Investigators: Study Director: Alessandro Haupenthal, Doctorate, Santa Catarina Federal University

Publications and helpful links

General Publications

• Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007 May;39(2):175-91. doi: 10.3758/bf03193146.
• ABIB, R. T. et al. Avaliação da diatermia por ondas curtas contínuo na temperatura superficial do músculo quadríceps. Ciência em Movimento, v. 1, n. 23, p. 69-77, 2010.
• BRASILEIRO, J. S.; FARIA, A. F.; QUEIROZ, L. L. Influància do resfriamento e do aquecimento local na flexibilidade dos músculos isquiotibiais. Revista Brasileira de Fisioterapia, v. 11, n. 1, p. 57-61, 2007.
• Delpizzo V, Joyner KH. On the safe use of microwave and shortwave diathermy units. Aust J Physiother. 1987;33(3):152-62. doi: 10.1016/S0004-9514(14)60592-4.
• Draper DO, Knight K, Fujiwara T, Castel JC. Temperature change in human muscle during and after pulsed short-wave diathermy. J Orthop Sports Phys Ther. 1999 Jan;29(1):13-8; discussion 19-22. doi: 10.2519/jospt.1999.29.1.13.
• Draper DO, Miner L, Knight KL, Ricard MD. The Carry-Over Effects of Diathermy and Stretching in Developing Hamstring Flexibility. J Athl Train. 2002 Mar;37(1):37-42.
• Garrett CL, Draper DO, Knight KL. Heat distribution in the lower leg from pulsed short-wave diathermy and ultrasound treatments. J Athl Train. 2000 Jan;35(1):50-5.
• Hawkes AR, Draper DO, Johnson AW, Diede MT, Rigby JH. Heating capacity of rebound shortwave diathermy and moist hot packs at superficial depths. J Athl Train. 2013 Jul-Aug;48(4):471-6. doi: 10.4085/1062-6050-48.3.04. Epub 2013 Mar 19.
• Ichinoseki-Sekine N, Naito H, Saga N, Ogura Y, Shiraishi M, Giombini A, Giovannini V, Katamoto S. Changes in muscle temperature induced by 434 MHz microwave hyperthermia. Br J Sports Med. 2007 Jul;41(7):425-9. doi: 10.1136/bjsm.2006.032540. Epub 2007 Jan 29.
• Peres SE, Draper DO, Knight KL, Ricard MD. Pulsed Shortwave Diathermy and Prolonged Long-Duration Stretching Increase Dorsiflexion Range of Motion More Than Identical Stretching Without Diathermy. J Athl Train. 2002 Mar;37(1):43-50.

Study record dates

Study Major Dates

• Study Start (Actual): September 3, 2018
• Primary Completion (Actual): December 10, 2018
• Study Completion (Actual): December 10, 2018

Study Registration Dates

• First Submitted: July 3, 2018
• First Submitted That Met QC Criteria: July 17, 2018
• First Posted (Actual): July 26, 2018

Study Record Updates

• Last Update Posted (Actual): May 12, 2020
• Last Update Submitted That Met QC Criteria: April 29, 2020
• Last Verified: April 1, 2020

More Information

Terms related to this study

• Keywords: Diathermy; Body temperature; Skin Temperature; Short-Wave Therapy
• Other Study ID Numbers: 1.771.454

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Yes
• IPD Plan Description: Means and standard deviations of temperature change.
• IPD Sharing Time Frame: Immediately following publication. No end date.
• IPD Sharing Access Criteria: Anyone who wishes to access the data.
• IPD Sharing Supporting Information Type: Study Protocol; Statistical Analysis Plan (SAP); Informed Consent Form (ICF)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No