OBJECTIVE: 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).
METHODS: 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.
RESULTS: 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.
CONCLUSION: There were no additional benefits of TENS, failing to support its use as a treatment adjunct within this context.
OBJECTIVE: To determine whether neuromuscular electrical stimulation applied to the quadriceps femoris muscle will enhance the effectiveness of an exercise programme in patients with knee osteoarthritis. DESIGN: A randomized trial with parallel intervention treatment groups. SETTING: Outpatient physical therapy clinic. Subjects: Fifty participants (mean age (SD) 68.9 (7.7) years) with symptomatic idiopathic knee osteoarthritis and radiographic evidence (grade ≥II Kelgren’s classification). INTERVENTIONS: Participants were randomized into one of two groups receiving 12 biweekly treatments: An exercise-only group or an exercise combined with neuromuscular electrical stimulation group (biphasic pulses, at 75 Hz and 250 μs phase duration). Main measures: Knee pain intensity; maximal voluntary isometric contraction and voluntary activation of the quadriceps femoris muscle; measures of functional performance. RESULTS: A significant interaction effect (<i>P</i> = 0.01) indicated greater improvement in pain for the electrical stimulation group. The mean (SD) change in pain intensity was from 7.5 ± 2 to 5 ± 2.2 and from 7.4 ± 1.9 to 3.3 ± 2.4 in the exercise and electrical stimulation groups, respectively. A significant treatment effect was also noted for the voluntary activation of the quadriceps femoris, which increased by 22.2% in the electrical stimulation group and by 9.6% in the exercise group (<i>P</i> = 0.045). Significant improvements were observed in both groups in all remaining measures, with no differences between groups. CONCLUSIONS: Electrical stimulation treatment to the quadriceps femoris enhanced the effectiveness of an exercise programme in alleviating pain and improving voluntary activation in patients with knee osteoarthritis, but did not enhance its effect on muscle strength or functional performance. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
OBJECTIVES: To evaluate the feasibility of a randomized-controlled trial (RCT) investigating the effects of adding auricular acupuncture (AA) to exercise for participants with chronic low-back pain (CLBP). METHODS: Participants with CLBP were recruited from primary care and a university population and were randomly allocated (n = 51) to 1 of 2 groups: (1) “Exercise Alone (E)”—12-week program consisting of 6 weeks of supervised exercise followed by 6 weeks unsupervised exercise (n = 27); or (2) “Exercise and AA (EAA)”—12-week exercise program and AA (n = 24). Outcome measures were recorded at baseline, week 8, week 13, and 6 months. The primary outcome measure was the Oswestry Disability Questionnaire. RESULTS: Participants in the EAA group demonstrated a greater mean improvement of 10.7% points (95% confidence interval, –15.3,-5.7) (effect size = 1.20) in the Oswestry Disability Questionnaire at 6 months compared with 6.7% points (95% confidence interval, -11.4,-1.9) in the E group (effect size = 0.58). There was also a trend towards a greater mean improvement in quality of life, LBP intensity and bothersomeness, and fear-avoidance beliefs in the EAA group. The dropout rate for this trial was lower than anticipated (15% at 6 mo), adherence with exercise was similar (72% E; 65% EAA). Adverse effects for AA ranged from 1% to 14% of participants. DISCUSSION: Findings of this study showed that a main RCT is feasible and that 56 participants per group would need to be recruited, using multiple recruitment approaches. AA was safe and demonstrated additional benefits when combined with exercise for people with CLBP, which requires confirmation in a fully powered RCT. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
OBJECTIVES: The aim of this study on persons with nonspecific chronic low back pain was to evaluate the effect of a multimodal physical therapy program with or without the addition of deep-water running on pain, physical disability, and general health.
DESIGN: A randomized controlled trial involving 46 subjects with nonspecific chronic low back pain were treated three times a week for 15 wks. Each group received 60 mins of multimodal physical therapy program (an individualized exercise program; manual therapy; and back care, pain education, and information on an active lifestyle), whereas one group performed additional 20-min sessions of deep-water running at an individual workload of the aerobic threshold.
RESULTS: Both interventions resulted in significant improvements in pain, disability, and physical health. The mean change in pain, disability, and physical health state were -36.1 ± 25.1 mm on the visual analog scale, -3.0 ± 4.8 points for the Roland Morris Questionnaire, and 10.6 ± 12.9 points for the Short Form-12 for the physical therapy plus deep-water running group and -34.1 ± 26.0 mm on the visual analog scale, -1.6 ± 1.5 points for the Roland Morris Questionnaire, and 8.9 ± 13.0 points for the Short Form-12 for the physical therapy alone group.
CONCLUSIONS: Pain, disability, health status, muscle strength and endurance, and lumbar range of motion significantly improved in both groups. The addition of a deep-water running program at an individual workload of the aerobic threshold to the multimodal physical therapy program produced a significant improvement in pain in patients with nonspecific chronic low back pain, but this was not significantly different when compared with multimodal physical therapy program alone. Disability, health status, muscle strength and endurance, and lumbar range of motion significantly improved to a similar level in both intervention groups.
Objective: To compare spinal manipulation, back school and individual physiotherapy in the treatment of chronic low back pain. Design: Randomized trial, 12-month follow-up. Setting: Outpatient rehabilitation department. Participants: 210 patients with chronic, non-specific low back pain, 140/210 women, age 59 ± 14 years. Interventions: Back school and individual physiotherapy scheduled 15 1-hour-sessions for 3 weeks. Back school included: Group exercise, education/ ergonomics; individual physiotherapy: Exercise, passive mobilization and soft-tissue treatment. Spinal manipulation, given according to Manual Medicine, scheduled 4 to 6 20-sessions once-a-week. Outcome: Roland Morris Disability Questionnaire (scoring 0-24) and Pain Rating Scale (scoring 0-6) were assessed at baseline, discharge 3, 6, and 12 months. Results: 205 patients completed the study. At discharge, disability score decreased by 3.7 ± 4.1 for back school, 4.4 ± 3.7 for individual physiotherapy, 6.7 ± 3.9 for manipulation; pain score reduction was 0.9 ± 1.1, 1.1 ± 1.0, 1.0 ± 1.1, respectively. At 12 months, disability score reduction was 4.2 ± 4.8 for back school, 4.0 ± 5.1 for individual physiotherapy, 5.9 ± 4.6 for manipulation; pain score reduction was 0.7 ± 1.2, 0.4 ± 1.3, and 1.5 ± 1.1, respectively. Spinal manipulation was associated with higher functional improvement and long-term pain relief than back school or individual physiotherapy, but received more further treatment at follow-ups (P<0.001); pain recurrences and drug intake were also reduced compared to back school (P <0.05) or individual physiotherapy (P <0.001). Conclusions: Spinal manipulation provided better short and long-term functional improvement, and more pain relief in the follow-up than either back school or individual physiotherapy.
STUDY DESIGN: A stratified randomized single-blinded clinical trial. OBJECTIVE: To compare the efficacies of 2 active therapies for chronic low back pain (CLBP). SUMMARY OF BACKGROUND DATA: Both a multidisciplinary biopsychosocial rehabilitation program and an intensive individual therapist-assisted back muscle strengthening exercise program used in Denmark have been reported to be effective for the treatment of CLBP. METHODS: A total of 286 patients with CLBP were randomized to either a group-based 12-week program comprising 73 hours of therapist exposure (approximately 12 h/patient): 35 hours of hard physical exercise, 22 hours of light exercise/occupational therapy, and 16 hours of education (group A) or a 12-week program comprising 1 hour of personal training twice a week, i.e., therapist exposure 24 h/patient (group B). At baseline and at 3, 6, 12, and 24 months, patients filled out questionnaires on pain (visual analogue scale [VAS]-pain average, which was the primary outcome measure), Roland-Morris disability questionnaire, global perceived outcome, and 36-Item Short-Form General Health Survey. Data were analyzed using the intention-to-treat principle. RESULTS: Of the 286 patients, 14 patients did not start treatment. Of the remaining patients, 25 (9%) dropped out of therapy. The 2 groups were comparable regarding baseline characteristic. After treatment, significant improvements were observed with regard to pain, disability, and most of the quality of life dimensions. These effects were sustained over the 24-month follow-up period. There were some statistically significant differences between the 2 groups relating to secondary end points, Roland-Morris disability questionnaire, and in the MOS 36-Item Short-Form Health Survey the 'physical functioning' dimension and the 'physical component summary.' CONCLUSION: Both groups showed long-term improvements in pain and disability scores, with only minor statistically significant differences between the 2 groups. The minor outcome difference in favor of the group-based multidisciplinary rehabilitation program is hardly of clinical interest for individual patients.
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).
METHODS:
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.
RESULTS:
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.
CONCLUSION:
There were no additional benefits of TENS, failing to support its use as a treatment adjunct within this context.
