Effectiveness of cryotherapy on pain intensity, range of motion, swelling and function in the postoperative care of musculoskeletal disorders: a systematic review and meta-analysis of randomised controlled trials.

Abstract

To investigate the effectiveness of cryotherapy on pain intensity, range of motion (ROM), swelling and function in the postoperative care of musculoskeletal disorders. Systematic review and meta-analysis, with estimates presented as mean differences (MDs) or standardised MDs (SMDs) with 95% CIs. Effect sizes were interpreted according to the minimum clinically important difference (MCID) of 2 points for pain and 11 points for function, or Cohen's thresholds. Searches were conducted in MEDLINE, COCHRANE, EMBASE and PEDro databases. Randomised controlled trials (RCTs) involving individuals undergoing postoperative rehabilitation for musculoskeletal disorders, comparing cryotherapy vs no cryotherapy, on pain intensity, ROM, swelling and function. 28 RCTs were included. The Grading of Recommendations Assessment, Development and Evaluation assessment demonstrated a very low to moderate certainty of evidence. For pain intensity, a statistically significant difference favouring cryotherapy was observed in the immediate (MD -0.77, 95% CI -1.23 to -0.31), short (MD -0.84, 95% CI -1.17 to -0.51) and medium term (MD -0.41, 95% CI -0.65 to -0.17). However, these effect sizes were below the MCID. For ROM, we found small to medium effect sizes in the immediate (SMD 0.37, 95% CI 0.09 to 0.66), short (SMD 0.51, 95% CI 0.25 to 0.77) and medium term (SMD 0.61, 95% CI 0.04 to 1.18). Small short-term effects were found for swelling (SMD -0.35, 95% CI -0.64 to -0.05) and function (MD 3.45, 95% CI 0.69 to 6.20; not clinically relevant). Cryotherapy produced minor benefits on pain intensity and ROM, but the effect sizes may not be clinically relevant. Evidence for swelling and function was of low certainty and showed no substantial benefit.