%D 2004 %0 ARTICLE %T Does Cryotherapy Improve Outcomes With Soft it issue Injury? %J %V 39 ( 3 ) %P 278-279 %A Hubbard TJ %A Denegar CR %M pub15496998 %X REFERENCE : Bleakley C , McDonough S , MacAuley D The use of ice in the treatment of acute soft-tissue injury : a systematic review of randomized controlled trials . Am J Sport Med . 2004 ; 32 : 251-261 . CLINICAL QUESTION : What is the clinical evidence base for cryotherapy use?DATA SOURCES : Studies were identified by using a computer-based literature search on a total of 8 databases : MEDLINE , Proquest , ISI Web of Science , Cumulative Index to Nursing and Allied Health ( CINAHL ) on Ovid , Allied and Complementary Medicine Database ( AMED ) on Ovid , Cochrane Database of Systematic Reviews , Cochrane Database of Abstracts of Reviews of Effectiveness , and Cochrane Controlled Trials Register ( Central ) . This was supplemented with citation tracking of relevant primary and review articles . Search terms included surgery , orthopaedics , sports injury , soft it issue injury , sprains and strains , contusions , athletic injury , acute , compression , cryotherapy , ice , RICE , andcold . STUDY SELECTION : To be included in the review , each study had to fulfill the following conditions : be a randomized , controlled trial of human subjects ; be published in English as a full paper ; include patients recovering from acute soft it issue or orthopaedic surgical interventions who received cryotherapy in inpatient , outpatient , or home-based treatment , in isolation or in combination with placebo or other therapies ; provide comparisons with no treatment , placebo , a different mode or protocol of cryotherapy , or other physiotherapeutic interventions ; and have outcome measures that included function ( subjective or objective ) , pain , swelling , or range of motion . DATA EXTRACTION : The study population , interventions , outcomes , follow-up , and reported results of the assessed trials were extracted and tabulated . The primary outcome measures were pain , swelling , and range of motion . Only 2 groups reported adequate data for return to normal function . All eligible articles were rated for methodologic quality using the PEDro scale . The PEDro scale is a checklist that examines the believability ( internal validity ) and the interpretability of trial quality . The 11-item checklist yields a maximum score of 10 if all criteria are satisfied . The intraclass correlation coefficient and kappa values are similar to those reported for 3 other frequently used quality scales ( Chalmers Scale , Jadad Scale , and Maastricht List ) . Two reviewers graded the articles , a method that has been reported to be more reliable than one evaluator . MAIN RESULTS : Specific search criteria identified 55 articles for review , of which 22 were eligible randomized , controlled clinical trials . The articles scores on the PEDro scale were low , ranging from 1 to 5 , with an average score of 3 . 4 . Five studies provided adequate information on the subjects baseline data , and only 3 studies concealed allocation during subject recruitment . No studies blinded their therapists administration of therapy , and just 1 study blinded subjects . Only 1 study included an intention-to-treat analysis . The average number of subjects in the studies was 66 . 7 ; however , only 1 group undertook a power analysis . The types of injuries varied widely ( eg , acute or surgical ) . No authors investigated subjects with muscle contusions or strains , and only 5 groups studied subjects with acute ligament sprains . The remaining 17 groups examined patients recovering from operative procedures ( anterior cruciate ligament repair , knee arthroscopy , lateral retinacular release , total knee and hip arthroplasties , and carpal tunnel release ) . Additionally , the mode of cryotherapy varied widely , as did the duration and frequency of cryotherapy application . The time period when cryotherapy was applied after injury ranged from immediately after injury to 1 to 3 days postinjury . Adequate information on the actual surface temperature of the cooling device was not provided in the selected studies . Most authors recorded outcome variables over short periods ( 1 week ) , with the longest reporting follow-ups of pain , swelling , and range of motion recorded at 4 weeks postinjury . Data in that study were insufficient to calculate effect size . Nine studies did not provide data of the key outcome measures , so individual study effect estimates could not be calculated . A total of 12 treatment comparisons were made . Ice submersion with simultaneous exercises was significantly more effective than heat and contrast therapy plus simultaneous exercises at reducing swelling . Ice was reported to be no different from ice and low-frequency or high-frequency electric stimulation in effect on swelling , pain , and range of motion . Ice alone seemed to be more effective than applying no form of cryotherapy after minor knee surgery in terms of pain , but no differences were reported for range of motion and girth . Continuous cryotherapy was associated with a significantly greater decrease in pain and wrist circumference after surgery than intermittent cryotherapy . Evidence was marginal that a single simultaneous treatment with ice and compression is no more effective than no cryotherapy after an ankle sprain . The authors reported ice to be no more effective than rehabilitation only with regard to pain , swelling , and range of motion . Ice and compression seemed to be significantly more effective than ice alone in terms of decreasing pain . Additionally , ice , compression , and a placebo injection reduced pain more than a placebo injection alone . Lastly , in 8 studies , there seemed to be little difference in the effectiveness of ice and compression compared with compression alone . Only 2 of the 8 groups reported significant differences in favor of ice and compression . CONCLUSIONS : Based on the available evidence , cryotherapy seems to be effective in decreasing pain . In comparison with other rehabilitation techniques , the efficacy of cryotherapy has been questioned . The exact effect of cryotherapy on more frequently treated acute injuries ( eg , muscle strains and contusions ) has not been fully elucidated . Additionally , the low methodologic quality of the available evidence is of concern . Many more high-quality studies are required to create evidence-based guidelines on the use of cryotherapy . These must focus on developing modes , durations , and frequencies of ice application that will optimize outcomes after injury .