Evaluation of the efficacy of physical agent modalities in patients with fractures: A systematic review and network meta-analysis

Lei Li¹Lishi Yang²Yue Yang²Jiayi Zhu²Rongnan Shi²Qi Deng²Jianxiong Wang^2,3,4Fuhua Sun^2,3,4*

• ¹Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
• ²The Affiliated Hospital of Southwest Medical University, Luzhou, China
• ³Southwest Medical University, Luzhou, China
• ⁴Rehabilitation Medicine and Engineering Key Laboratory of Luzhou, Luzhou, China

Background: Fractures are increasing due to ageing populations. Physical agent modalities, a non-invasive treatment, enhances healing and reduces nonunion risk. Objective: This meta-analysis evaluates the effectiveness of physical agent modalities in patients with fractures and compares the outcomes of different interventions on healing and pain relief. Methods: Articles published up to April 2025 were retrieved from PubMed, Embase, and Web of Science. Two authors independently reviewed and extracted data from randomised controlled trials assessing seven types of physical agent modalities: Electrical Stimulation (ES), Pulsed Electromagnetic Fields Stimulation (PEMFS), Ultrasound Therapy (UST), Low-Level Laser Therapy (LLLT), Magnetic Stimulation (MS), Extracorporeal Shock Wave Therapy (ESWT), and Capacitively Coupled Electric Field Stimulation (CCEFS). Standard meta-analysis and network meta-analysis (NMA) were performed for three outcomes: Pain Relief Difference, Time to Complete Fracture Healing(days), and Number of Cases Achieving Complete Fracture Healing. Cumulative ranking curves (SUCRA) scores were calculated for each therapy, with data presented as mean differences (MD) and 95% confidence intervals (CI). Results: This meta-analysis includes studies with 2,379 participants. The standard meta-analysis results show that physical agent modalities can markedly enhance fracture healing, with significant pain relief (MD = 1.30, 95% CI: 0.61, 1.99), P = 0.0002, shorter time to complete fracture healing(days) (MD = -21.58, 95% CI: -31.05, -12.11), P < 0.0001, and more number of cases achieving complete fracture healing (RR = 1.37, 95% CI: 1.17, 1.60), P < 0.0001. However, the NMA findings indicate that most direct or indirect comparisons between different physical agent therapies yield pooled effect sizes whose 95% confidence intervals include the null value (0 or 1), showing no significant differences between groups.SUCRA rankings revealed that LLLT (87.5%) and ES (80.8%) were more effective in pain relief, while UST (82.9%) and CCEFS (99.9%) excelled in promoting fracture healing. Conclusion: LLLT, ES, UST, and CCEFS may yield improved outcomes for fracture patients; however, further high-quality, large-scale randomised controlled trials are required to validate these findings.