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Practice Rapid Recommendations

Low intensity pulsed ultrasound (LIPUS) for bone healing: a clinical practice guideline

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j576 (Published 21 February 2017) Cite this as: BMJ 2017;356:j576

Population

Adults and children with a fracture or osteotomy

Choice of intervention

or LIPUS No ultrasound Standard care without ultrasound Low intensity pulsed ultrasound, used to stimulate bone growth (osteogenesis)

Recommendations

Population Favours LIPUS Favours no ultrasound

All Why? We recommend against the use of LIPUS Strong Benefits outweigh harms for almost everyone. All or nearly all informed patients would likely want this option. Strong Benefits outweigh harms for almost everyone. All or nearly all informed patients would likely want this option. Weak Benefits outweigh harms for the majority, but not for everyone. The majority of patients would likely want this option. Weak Benefits outweigh harms for the majority, but not for everyone. The majority of patients would likely want this option.

Comparison of benefits and harms Key practical issues Evidence quality Summary Favours LIPUS Favours no ultrasound See full details LIPUS No ultrasound 150 No important difference The panel unanimously agreed that all or nearly all informed patients would elect not to apply LIPUS. Preferences and values Resourcing Other considerations Days to radiographic healing Days to return to work Subsequent operations Device-related adverse effects LIPUS is a costly device which does not represent a wise use of health resources. Number of days (mean) 205 Events per 1000 people 160 0 0 147 200 No important difference 70 Pain score (0–100, lower better) Mean value 40 39 No important difference No important difference No important difference No important difference Days to full weight bearing 73 No important difference LIPUS may be burdensome to use. This is reflected in the TRUST trial, in which many patients reported limited compliance. Usually used for 15-20 minutes each day for 14 to 140 days No practical issues Device can be cumbersome to travel with Health insurance may not cover cost 128 LIPUS probably has little or no impact on time to radiographic healing Moderate Moderate quality evidence We are moderately confident in the evidence supporting the recommendation. Further research could have an important impact, which may change the estimates of effect. LIPUS probably has little or no impact on time to return to work Moderate Moderate quality evidence We are moderately confident in the evidence supporting the recommendation. Further research could have an important impact, which may change the estimates of effect. LIPUS has no impact on time to full weight bearing High High quality evidence We are very confident in the evidence supporting the recommendation. Further research is very unlikely to change the estimates of effect. LIPUS has no impact on pain reduction High High quality evidence We are very confident in the evidence supporting the recommendation. Further research is very unlikely to change the estimates of effect. LIPUS probably has little or no impact on subsequent operation Moderate Moderate quality evidence We are moderately confident in the evidence supporting the recommendation. Further research could have an important impact, which may change the estimates of effect. LIPUS has no impact on device-related adverse effects High High quality evidence We are very confident in the evidence supporting the recommendation. Further research is very unlikely to change the estimates of effect.

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