Is neuromuscular electrical stimulation effective for improving pain, function and activities of daily living of knee osteoarthritis patients? A randomized clinical trial

Abstract

CONTEXT AND OBJECTIVE Neuromuscular electrical stimulation (NMES) has been used in rehabilitation protocols for patients suffering from muscle weakness resulting from knee osteoarthritis. The purpose of the present study was to assess the effectiveness of an eight-week treatment program of NMES combined with exercises, for improving pain and function among patients with knee osteoarthritis. DESIGN AND SETTING Randomized clinical trial at Interlagos Specialty Ambulatory Clinic, Sao Paulo, Brazil. METHODS One hundred were randomized into two groups: NMES group and control group. The following evaluation measurements were used: numerical pain scale from 0 to 10, timed up and go (TUG) test, Lequesne index and activities of daily living (ADL) scale. RESULTS Eighty-two patients completed the study. From intention-to-treat (ITT) analysis comparing the groups, the NMES group showed a statistically significant improvement in relation to the control group, regarding pain intensity (difference between means: 1.67 [0.31 to 3.02]; P = 0.01), Lequesne index (difference between means: 1.98 [0.15 to 3.79]; P = 0.03) and ADL scale (difference between means: -11.23 [-19.88 to -2.57]; P = 0.01). CONCLUSION NMES, within a rehabilitation protocol for patients with knee osteoarthritis, is effective for improving pain, function and activities of daily living, in comparison with a group that received an orientation program. CLINICAL TRIAL REGISTRATION ACTRN012607000357459.

Neuromuscular Electrical Stimulation for Treatment of Muscle Impairment: Critical Review and Recommendations for Clinical Practice

“…132 NMES is indicated to strengthen weak quads muscles, train endurance, minimize atrophy, and increase ROM at the joint. 4,133,134 NMES waveform: low-frequency biphasic PC [135][136][137][138][139] Frequency: 50 Hz [135][136][137][138][139] Pulse duration: 250-300 ms [135][136][137][138][139][140] Current amplitude: individual max tolerated intensity 135,138,140 Work-rest cycle: ON:OFF 10:50 s (1:5 ratio) 135,137,139 Treatment schedule: 15-20 contractions with Ex [135][136][137]139 Session frequency: 3 d/wk, 4-8 wk [135][136][137][138][139][140] Z Strength (OHAUS dynamometer, Kin-Com, 1 RM, 10 RM) 136,139,140 Z Improved self-reported function (WOMAC, SF-36) [135][136][137]140,141 Z Improved function (SCT, 6MWT, 25-metre walk test, TUG) 135...…”

“…136,139,140 Function and endurance increased in 3 (1 a marginal effect) of 4 studies that measured endurance. 135,136,138 Pain decreased in 4 of 6 studies that measured pain. [136][137][138]140 The recommended protocol is based on 5 studies.…”

Phisical modalities on the functional performance in knee osteoarthritis: a sytematic review

“…Scientific evidences used in this review show that the neuromuscular electrical stimulation (NMES) may be beneficial in patients with knee OA in variables such as pain (6,(23)(24)(25)(26), physical function (6,23,25), functional performance (25,27), discomfort (6), daily living activities (6) and stiffness (23,25). Furthermore, NMES seems to compensate physiological declines occurring in the muscle of patients, acting both in structure as in function of the quadriceps (23) by means of cross-sectional area increases (23,27) and muscular strength (23,25) and also in the improvement of voluntary muscle activation when combined with an exercise program (24).…”

“…Furthermore, NMES seems to compensate physiological declines occurring in the muscle of patients, acting both in structure as in function of the quadriceps (23) by means of cross-sectional area increases (23,27) and muscular strength (23,25) and also in the improvement of voluntary muscle activation when combined with an exercise program (24). The parameters used in these studies (6,(23)(24)(25)(26)(27) varied from: 50-80Hz, 100-400μs, intensity: visible muscle contraction until the maximum tolerated, time on: 10 seconds, off time: 10-50 seconds 15-45 minutes per session, for 12-36 sessions.…”

“…The objective of non pharmacological treatments, including physical therapy, is the relief of the signs and symptoms of the disease and, if possible, the delay in progression, being that various treatments have been used for this purpose, including therapeutic ultrasound (5), electrical stimulation (5,6) and the low power laser (7).…”