Abstract

To determine the additional effects of transcutaneous electrical nerve stimulation (TENS) for knee osteoarthritis (OA) when combined with a group education and exercise program (knee group). The study was a randomized, sham-controlled clinical trial. Patients referred for physiotherapy with suspected knee OA (confirmed using the American College of Rheumatology clinical criteria) were invited. Exclusion criteria included comorbidities preventing exercise, previous TENS experience, and TENS contraindications. Prospective sample size calculations required 67 participants in each trial arm. A total of 224 participants (mean age 61 years, 37% men) were randomized to 3 arms: TENS and knee group (n = 73), sham TENS and knee group (n = 74), and knee group (n = 77). All patients entered an evidence-based 6-week group education and exercise program (knee group). Active TENS produced a "strong but comfortable" paraesthesia within the painful area and was used as much as needed during the 6-week period. Sham TENS used dummy devices with no electrical output. Blinded assessment took place at baseline and 3, 6, 12, and 24 weeks. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function subscale at 6 weeks. Secondary outcomes included WOMAC pain, stiffness, and total scores; extensor muscle torque; global assessment of change; exercise adherence; and exercise self-efficacy. Data analysis was by intent to treat. All outcomes improved over time (P < 0.05), but there were no differences between trial arms (P > 0.05). All improvements were maintained at 24-week followup. There were no additional benefits of TENS, failing to support its use as a treatment adjunct within this context.

Highlights

  • IntroductionKnee osteoarthritis (OA) is associated with pain, decreased range of movement and muscle weakness which over time may lead to functional loss [1] and substantial economic burden [2]. 16.3% of men and 29.1% of women over 55 years exhibit radiographic evidence of knee OA, with age, pain and stiffness contributing to locomotor disability [3]

  • There were no additional benefits of Transcutaneous Electrical Nerve Stimulation (TENS), failing to support its use as a treatment adjunct within this context

  • Knee osteoarthritis (OA) is associated with pain, decreased range of movement and muscle weakness which over time may lead to functional loss [1] and substantial economic burden [2]. 16.3% of men and 29.1% of women over 55 years exhibit radiographic evidence of knee OA, with age, pain and stiffness contributing to locomotor disability [3]

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Summary

Introduction

Knee osteoarthritis (OA) is associated with pain, decreased range of movement and muscle weakness which over time may lead to functional loss [1] and substantial economic burden [2]. 16.3% of men and 29.1% of women over 55 years exhibit radiographic evidence of knee OA, with age, pain and stiffness contributing to locomotor disability [3]. Cochrane reviews of the evidence for knee OA interventions have indicated that exercise is effective for both pain and function [4, 5]. The latest Cochrane review exploring Transcutaneous Electrical Nerve Stimulation (TENS), was unable to support its effectiveness for pain relief [6]. Clinical guidelines recommend exercise and patient education as core treatments, with TENS as an adjunct [9]. Elucidation of the effects of TENS when combined with exercise and education is an important clinical research question. Such effects have yet to be clearly established, with a limited number of previous studies in knee OA

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