This review addressed a clear objective supported by defined inclusion criteria for patients, study design and interventions, but not for outcomes. Relevant sources were searched for English-language studies, so there was a possibility of language bias. Some studies may have been missed as the authors did not undertake an extensive search for unpublished studies. It was unclear whether appropriate steps were taken to reduce reviewer error and bias in the selection of studies and data extraction. Study quality was not formally assessed and so the reliability of the included studies was unclear. Some quality criteria were discussed within the review and (as acknowledged by the authors) shortcomings among the included studies included poor study designs, small sample sizes (most studies had <50 participants), limited information on treatment volume or intensity, concomitant use of conventional physical therapy modalities and a lack of long-term follow-up. A narrative synthesis was appropriate given the differences between studies.
The authors’ conclusions appeared to reflect the limited evidence, but the possibility of bias, uncertainty over the review methods and poor study quality suggest that these should be interpreted with caution.