Transcutaneous Electrical Nerve Stimulation and Interferential Current Combined with Exercise for the Treatment of Knee Osteoarthritis: A Randomised Controlled Trial
Article Outline
Abstract
Interferential current (IFC) and transcutaneous electrical nerve stimulation (TENS) are forms of electrical stimulation frequently used to treat knee osteoarthritis (OA). The relative effectiveness of these two modalities is currently unknown. The purpose of this study was to evaluate the effects of IFC and TENS, when used in conjunction with exercise, on pain and function in patients with knee OA. Forty-six subjects with radiographically confirmed OA were randomly assigned to one of three groups: TENS and standardised exercises, IFC and exercises or exercises alone. An electrical stimulator was used to apply IFC or TENS at 80 Hz for 20 minutes. All groups had a standardised exercise programme. Treatment was applied twice per week for 4 weeks. Outcomes included a 10-point pain rating scale for pain intensity and the Western Ontario and McMaster University Osteoarthritis Index (WOMAC). A two-way repeated measures ANOVA performed on the pain assessment score showed a statistically significant effect of time (p < 0.001), but not of experimental group (p = 0.813) or interaction (p = 0.067). A similar result was obtained for WOMAC score (p < 0.001, p = 0.241 and p = 0.130 for time, group and interaction effects, respectively). All treatment protocols led to significant improvements in pain and function over time. Neither IFC nor TENS displayed significant additional effects over exercise alone.
Key words: interferential current , TENS , exercise , osteoarthritis
No full text is available. To read the body of this article, please view the PDF online.
References
- Specific diseases and their effects on functional limitations in elders in the Framingham study . Am J Public Health . 1994;84:351–358
- . The course of osteoarthritis and factors that affect it . Rheum Dis Clinic North Am . 1993;19:607–615
- . Rheumatics' diseases . In: Nelder FH editors. The Gba Collection of Medical Illustrations . Gmmit SFA: Ciba-Geigy Corporation; 1990;p. 178–181
- . Pathomechanics of knee osteoarthritis . Med Sci Sports Exerc . 1994;26:1–34 429
- . Effects of non-steroidal anti-inflammatory drugs on chondrolyte metabolism in vitro and vivo . Am J Med . 1987;83:29–34
- Comparison of an antiinflammatory dose of ibuprofen, an analgesic dose of ibuprofen, and acetaminophen in the treatment of patients with osteoarthritis of the knee . N Engl J Med . 1991;325:87–91
- . Published trials of non-medicinal and non-invasive therapies for hip and knee osteoarthritis . Ann Intern Med . 1994;121:133–140
- . Acupuncture for osteoarthris of the knee: a systematic review . Arthritis Rheum . 2001;44:819–825
- . Interferential current for pain control . In: Kitchen S , Bazin S editor. Electrotherapy: Evidence-based th Practice, 11 edition . Edinburgh: Churchill Livingston; 2002;p. 287–300
- Management of non-specific low back pain by physiotherapists in Britain and Ireland: a descriptive questionnaire of current clinical practice . Spine . 1999;24:1–42 332
- . Transcutaneous electrical nerve stimulation (TENS) . In: Kitchen S editors. Electrotherapy: Evidence-based Practice . Edinburgh: Churchill Livingston; 2001;p. 259–286
- . Interferential current therapy . Br J Sports Med . 1990;24:87–92
- . Interferential current news . Phys Ther . 1987;67:280–281
- Information and advice to patients with back pain can have a positive effect. A randomized controlled trial of a novel educational booklet in primary care . Spine . 1999;24:2–91 484
- Quadriceps strength and osteoarthritis progression in malaligned and lax knees . Osteoarthritis Cartilage . 2003;11:252–259
- Efficacy of interferential current stimulation alone for pain reduction in patients with osteoarthritis of the knee: a randomized placebo control clinical trial . Phys Ther . 1991;71:552; (Abstract)
- . Analgesic effects of transcutaneous electrical nerve stimulation and interferential circuits on heat pain in healthy subjects . J Rehabil Med . 2003;35:15–19
- . An evaluation of interferential therapy, shortwave diathermy and exercise in the treatment of osteoarthritis of the knee . Physiotherapy . 1985;7:55–57
- . Effects of interferential current stimulation in management of osteoarthritic knee pain . Physiotherapy . 2002;88:493–499
- . Transcutaneous electrical nerve stimulation (TENS) and TENS like devices; do they produces pain relief? . Pain Review . 2001;8:122–158
- . Does four weeks of TENS and/or isometric exercise produce cumulative reduction of osteoarthritis knee pain? . Clin Rehabil . 2002;16:749–760
- Optimal stimulation duration of TENS in the management of osteoarthritic knee pain . J Rehabil Med . 2003;35:62–68
- . The analgesic effects of interferential therapy compared with TENS on experimental cold induced pain in normal subjects . Physiotherapy . 1995;81:741
- . Electrotherapy for pain relief: does it work? A laboratory based study to examine the analgesic effects of electrotherapy on cold induced pain in healthy individuals . Clin Effect Nurs . 1999;3:14–24
- . A double-blind placebo-controlled investigation into the analgesic effects of inferential currents and transcutaneous electrical nerve stimulation on cold induced pain in healthy subjects . Physiother Theory Pract . 1999;15:217–233
- . The effect of three electrotherapeutic modalities upon peripheral nerve conduction and mechanical pain threshold . Clin Physiol . 2001;21:704–711
- . Effects of electric stimulation on C and A delta fiber-mediated thermal perception thresholds . Arch Phys Med Rehabil . 2004;85:119–128
- A comparison of various therapeutic exercises on the functional status of patients with knee osteoarthritis . Semin Arthritis Rheum . 2003;36:398–406
- Intensity of exercise for the treatment of osteoarthritis . Cochrane Database Syst Rev . 2003; CD004259. (Abstract)
- . Sample Size Tables for Clinical Studies . 2 edition. Malden, MA: Blackwell Science; 1997;
- . Evaluation of musculoskeletal disorders . In: Gould JA , Davies GJ editor. Orthopaedic and Sports Physical Therapy . St Louis: Mosby; 1985;p. 169–180
- . The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties . Arthritis Rheum . 2001;45:453–461
- . Physiological bases of perceived exertion . Med Sci Sport Exerc . 1982;14:377–381
- . Techniques of progression exercise . Arch Phys Med Rehabil . 1948;29:263
- . In: Therapeutic Exercise: Foundation and Techniques . Philadelphia: FA Davis Company; 1990;p. 109–146
- . In: Exercise in Health and Disease: Evaluation and Prescription for Prevention and Rehabilitation . 2 edition. Philadelphia: W.B. Saunders Company; 1990;p. 259–266
- . Effectiveness and safety of strengthening, aerobic, and coordination exercises for patients with osteoarthritis . Curr Opin Rheumatol . 2003;15:141–144
- . Interferential current as an adjunct to exercise and mobilization in the treatment of proximal humerus fracture pain: lack of evidence of an additional effect . Physiotherapy . 2000;86:147
- Transcutaneous electrical nerve stimulation for knee osteoarthritis . Cochrane Database Syst Rev . 2002;(1):
- . Exercise for osteoarthritis of the hip or knee . Cochrane Database Syst Rev . 2004;(1):
- Home based exercise programme for knee pain and knee osteoarthritis randomized controlled trial . BMJ . 2002;325:752
- The effect of dynamic versus isometric resistance training on pain and functioning among adults with osteoarthritis of the knee . Arch Phys Med Rehabil . 2002;83:1189–1195
- . In osteoarthritis, the psychosocial benefits of exercise are as important as physiological improvements . Exerc Sport Sci Rev . 2003;31:138–143
- Exploring the factorial validity and clinical interpretability of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) . Physiother Can . 2003;55:160–168
PII: S1013-7025(09)70054-5
doi:10.1016/S1013-7025(09)70054-5
© 2005 Elsevier. Published by Elsevier Inc. All rights reserved.
