Each recommendation is followed by recommendation grades (Level I or II and A, B, C+, C and D). Definitions of the recommendation grades are presented at the end of the "Major Recommendations" field.
Low-level Laser Therapy (LLLT)
LLLT applied to the foot, knee, or hand versus a placebo, level I (randomized controlled trial [RCT]): Grade A for pain at 3 months (clinically important benefit); grade C for function, tender joints, muscle force, and range of motion (ROM) at 3 and 6 months (no benefit). Patients with chronic rheumatoid arthritis (RA).
Therapeutic Ultrasound
Therapeutic ultrasound performed on the hand in water versus a placebo, level I (RCT): Grade A for tender joints at 10 weeks (clinically important benefit); grade C for swollen joints and morning stiffness at 10 weeks (no benefit). Patients with RA involving the hand (functional class I or II, chronic stage).
Thermotherapy
Cryotherapy applied to the knee joint versus a control, level I (RCT): Grade C for thermographic index (measurement [in degrees Celsius] obtained using infrared thermography of the joint) at 5 days (no benefit). Patients with chronic RA, and with obvious effusion of joints.
Wax applied to the hand and wrist versus a control, level I (RCT): Grade C for pain, ROM, muscle force, and function at 1 month (no benefit). Patients with functional class I or II with hands affected.
Wax applied to the hand or wrist and hand exercises versus a control, level I (RCT): Grade A for ROM at 1 month (clinically important benefit), grade C+ for pain and stiffness at 1 month (clinical benefit), grade C for muscle force and function at 1 month (no benefit). Patients with functional class I or II with hands affected.
Transcutaneous Electrical Nerve Stimulation (TENS)
Low-frequency TENS applied to the hand and wrist versus no stimulation, level I (RCT): Grade A for pain at 3 weeks (clinically important benefit), grade C+ for power at 3 weeks (clinical benefit), grade C for work at 3 weeks (no benefit). Patients with chronic RA.
High-frequency TENS applied to the hand and wrist versus placebo, level I (RCT): Grade C for pain and joint tenderness, same day (no benefit). Patients with chronic RA.
High- versus low-frequency TENS applied to the hand and wrist, level I (RCT): Grade C for global patient (patient's assessment of overall disease activity or improvement) (Ottawa Panel, 2004) at 2 weeks (clinical benefit). Patients with chronic RA.
Definitions:
The recommendations were graded by their level (I for RCTs, II for nonrandomized studies) and strength (A, B, C+, C, or D) of evidence.
Grade A: Evidence from one or more RCTs of a statistically significant, clinically important benefit (>15%)
Grade B: Statistically significant, clinically important benefit (>15%) if the evidence was from observational studies or CCTs
Grade C+: Evidence of clinical importance (>15%) but not statistical significance
Grade C: Appropriate outcome was measured in a study that met the inclusion criteria but no clinically important difference and no statistical significance were shown
Grade D: Evidence from one or more RCTs of a statistically significant benefit favoring the control group (<0%: favors controls.)
