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Using TENS to enhance therapeutic exercise in individuals with knee osteoarthritis
Pietrosimone B, Luc-Harkey BA, Harkey MS, Davis-Wilson HC, Pfeiffer SJ, Schwartz TA, Nissman D, Padua DA, Blackburn JT, Spang JT
Medicine and Science in Sports and Exercise 2020 Oct;52(10):2086-2095
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

Transcutaneous electrical nerve stimulation (TENS) facilitates quadriceps voluntary activation in experimental settings. Augmenting therapeutic exercise (TE) with TENS may enhance the benefits of TE in individuals with knee osteoarthritis (KOA) and quadriceps voluntary activation failure (QVAF). PURPOSE: To determine the effect of TENS+TE on patient-reported function, quadriceps strength and voluntary activation, as well as physical performance compared to sham TENS+TE (Sham), and TE alone in individuals with symptomatic KOA and QVAF. METHODS: Ninety individuals participated in a double-blinded randomized controlled trial. Everyone received 10 standardized TE sessions of physical therapy. TENS plus TE and Sham groups applied the respective devices during all TE sessions and throughout activities of daily living over 4 weeks. The Western Ontario and McMaster University Osteoarthritis Index (WOMAC), quadriceps strength and voluntary activation, as well as a 20-meter walk test, chair-stand test, and stair-climb test were performed at baseline, following the 4-week intervention (post 1) and at 8 weeks following the start of the intervention (post 2). Mixed effects models were used to determine between-group differences between baseline and post 1, as well as baseline and post 2. RESULTS: Improvements in WOMAC subscales, quadriceps strength and voluntary activation, 20-meter walk times, chair-stand repetitions, and stair-climb time were found at post 1 and post 2 compared to baseline for all groups (p < 0.05). WOMAC pain and stiffness improved in the TENS plus TE group compared to TE alone at post 1 (p < 0.05); yet no other between-group differences were found. CONCLUSIONS: TE effectively improved patient-reported function, quadriceps strength and voluntary activation, as well as physical performance in individuals with symptomatic KOA and QVAF, but augmenting TE with TENS did not improve the benefits of TE.

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