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DOI: Tel: E-mail: b. Purpose: Radiofrequency-based electrophysical agents are widely used in therapy-related clinical practice for their thermal effects, mainly relieving pain and inflammation and improving tissue extensibility.

The most commonly used and researched are shortwave therapies that operate at Although relatively new, electrophysical agents employing much lower frequencies have also emerged. Capacitive resistive monopolar radiofrequency employing kHz is one such therapy. This laboratory-based study was aimed to investigate the skin thermal responses to kHz radiofrequency-based therapy in healthy adults.

Starting at minimum, the intensity was increased incrementally until thermal discomfort was felt. Participants reported three time points: thermal onset, definite thermal sensation, and onset of thermal discomfort. Local skin temperature was measured before, immediately post-treatment and up to 45 min posttreatment. Results: Both capacitive and resistive modes of therapy significantly increased the skin temperature and sustained it over the min follow-up.

There was statistically significant difference between the thermal response patterns produced by the two modes. Peak posttreatment temperatures attained were not significantly different between the two; however, the retention rate at follow-up was significantly higher for the resistive mode. Conclusions: This study confirms that radiofrequency-based therapy at kHz can significantly increase and sustain skin temperature. The study also provides useful baseline data for further research in the low frequency ranges of radiofrequency-based therapy that remain largely unexplored.

Electrophysical agents EPAs are used by therapists to treat a wide variety of conditions. Some of these agents can induce hyperthermia in tissues without being invasive or ablative. While some produce superficial heating to the area of the body where the modality is applied for example, infrared IR therapy , others such as radiofrequency electromagnetic field RFEMF, or simply RF -based EPAs are capable of heating the skin as well as deeper structures such as muscles and joint tissues [1].

The physiological effects of heat on living tissues are well documented. Heat can induce changes in the superficial and deep tissues, at cellular and systemic levels. Heat can also change the nature of connective tissues. It can alter the properties of tendons, ligaments and, to some extent muscle, by means of increasing the extensibility and reducing the tone and spasm [1—3].

The extent of physiological effect may vary depending on the level of exposure. In therapy, heat application is often used as a mode to relieve pain and inflammation and potentially enhance tissue healing. Various physiological mechanisms are believed to underpin the effects of heat on pain and tissue repair including but not limited to changes arising from an increase in the blood flow, oxygen uptake and chemical reaction rates. Therapeutically, a rise in tissue temperature by more than 1 o C will help to relieve mild inflammation and an increase of 2—3 o C will help to reduce pain and muscle spasm, whereas an increase of 3—4 o C can produce changes in tissue extensibility [3,4].

Radiofrequency-based EPAs have been employed for various levels of heat treatment in therapy practice since the early decades of the last century [5]. The electromagnetic energy delivered by these devices generates heat in the tissues as a result of the oscillation and friction of charged molecules such as proteins and ions. The rise in temperature itself is dependent upon the electrical properties of the tissues and the rate at which the energy is absorbed specific absorption rate, SAR [1,6].

Among the EPAs that are used to induce mild hyperthermia, longwave diathermy which employed RF fields of around 0. However, microwave therapy is currently used infrequently in many countries [8,9]. CSWT has been widely used by clinicians since the s but has now become less popular and is infrequently used in the western world [8,10].

By contrast, PSWT, which was developed in the s, has since become the more popular delivery option and is still used widely [8,10,12]. The majority of research on the biological effects of RF is centred on the higher frequency microwaves , particularly areas such as mobile telephony [13]. However, a recent review of literature undertaken by the authors of this study [14] indicated that the RF currently used in therapy-related clinical practice is predominantly within the relatively lower frequency range of 30 kHz—30MHz and largely limited to the shortwave range of 10—30MHz especially PSWT at Although the research is sparse, EPAs operating at significantly lower RF ranges 5 1 MHz have also been reported and used in clinical practice to induce mild hyperthermia and other physiological effects [15—18].

In this study the authors aimed to investigate the skin thermal responses thermal effects to the cutaneous application of continuous mode CRMRF therapy in healthy adults. The equipment was factory calibrated and pretested for accuracy of output. A manufacturer-supplied conductive cream was employed as a coupling medium between the electrode and the skin surface. The CAP electrode has a polyamide coating that acts as a dielectric medium, insulating its metallic body from the skin surface, thus forming a capacitor with the treated tissues.

The RES electrode is uncoated and passes RF energy directly through the body and into the neutral plate. The RF intensity and the energy output Figure 1 is shown on the machine display, which is also wirelessly recorded by a computer-based monitoring software programme in the research environment. A detailed log of the experimental data can be exported via the monitoring software. Abody composition monitor Omron Healthcare Europe B.

An electronic metronome Seiko Instruments Inc. The room temperature and humidity were monitored using an electronic thermohygrometer RS Components Pte Ltd. Sample and groups A randomly selected cohort of 15 asymptomatic self-reported adults from among the 27 staff and students of the University of Hertfordshire participated in the study.

The recruitment was done through e-mails that were sent out university-wide. The respondents were screened for inclusion consecutively, and the first 15 eligible subjects were recruited eligibility criteria explained below. All participants signed an informed consent prior to the study. Each participant attended two sessions; one each for the CAP and the RES modes thus forming two separate treatment groups. There were no control or placebo groups.

Based on pilot experiments, a minimum gap of 48 h was allowed between the two sessions so that no residual effects from the first session. Figure 1. Graphs showing the output data as obtained from the device monitoring software. The data shown are from one participant No. Figure 2. The experimental setting with the kHz capacitive resistive monopolar radiofrequency CRMRF device Indiba Activ , electrodes and the computerbased monitoring software.

The participants were screened using an eligibility questionnaire including questions relating to any recent injury or illness and accepted contraindications to RF therapy pregnancy, malignancy, metal or electronic implants in the body. The participants were required to distinguish between the three temperatures in order to continue with their participation in the study.

After this screening, demographic and anthropometric data were collected. To receive treatment, the participants were asked to lie down in a supine position on a treatment plinth and were fully supported with pillows Figure 2.

A square area covering the lower quarter of the anterior aspect of the right thigh was marked with tape. The local skin temperature was recorded from the centre of the marked square area on the treated leg and the corresponding area of the untreated leg. The untreated leg served as a control. The core tympanic temperature was also concurrently monitored. The local skin temperature measurements were repeated every 2 min until it stabilised, which was then considered the baseline skin temperature.

The neutral plate electrode was smeared with 20 ml of conductive cream and placed under the calf muscle belly, one quarter of the way down the distance from the fibular head to the lateral malleolus of the treated leg. The CRMRF treatment was applied with the active electrode using 20 ml of cream in the marked square area. The intensity started at the lowest level permitted by the device and was raised by one level every 30 s.

The participants were instructed to report clearly and promptly at three time points: Firstly, when they start to feel heat on the skin thermal onset , secondly, when they feel moderate yet comfortable heat definite thermal sensation , and thirdly, when the heat starts to become uncomfortable onset of thermal discomfort.

All three time points and the corresponding treatment intensity were recorded. After clearing the treated area, the post-treatment peak skin temperature was recorded from either leg from the same spot used for the baseline measurement. The core temperature was also recorded at this time. The skin temperature measurements were repeated follow-up subsequently every 30 s on the treated leg and every 5 min on the control leg for the next 45 min, or till the temperature on the treated side returned to the baseline level whichever was earlier.

Core temperature, room temperature and humidity measurements were also repeated at the end of the experiment. In addition, a second brief experiment was conducted separately, to map the temperature changes in the active treatment electrodes at various stages of testing in response to set intensities expressed as percentages of application of the CRMRF energy.

For this purpose three arbitrary intensity levels were chosen, alongside a fourth level which would be the mean peak power reached during each mode of the main experiment. The group data were compared using a two-way repeated measures analysis of. Table 1. Figure 3. The data shown baseline, post-treatment and min follow-up are from 15 participants. All 15 participants completed both sessions of the study and the assessments as anticipated.

The RF treatment was well tolerated and there were no reports of any adverse events that may be a consequence of the intervention, including any issues due to potential overheating. Figure 6 A—C shows the individual data for the mean time, mean energy and mean peak power reported in Table 2. Figure 4. The data shown thermal build-up, thermal decay and thermal retention are the changes in relation to the baseline from 15 participants.

There was no significant difference between the baseline skin temperatures of the two groups. From baseline to peak there was However, the rate of temperature retention at the min follow-up was significantly higher for the RES mode compared to that of the CAP mode No meaningful change was noted in the thermal response of either the untreated control side or the core tympanic temperature at any time point in either group. The temperature changes recorded from the two active electrodes during the second experiment are reported in Table 3.

The literature surrounding the thermophysiological effects of RF on biological systems is extensive. Most of the published research in this area has been conducted on laboratory animals, the emphasis being particularly on rodents. It has been argued that these small mammals are poor models for human beings as their physiological heat loss mechanisms are limited, thus making extrapolation of the results from such studies to human beings difficult [6]. For example, rodents mice in particular have a higher thermoneutral zone of around 30 o C whereas for humans wearing clothes it is 22—25 o C [19—21].

Whether or not RF exposure to the human body produces a thermal effect depends on many parameters of the wave; such as its frequency, intensity, duration of exposure and the area of. Figure 5.


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