Effectiveness of neuromuscular electrical stimulation training combined with exercise on patient‐reported outcomes measures in people with knee osteoarthritis: A systematic review and meta‐analysis

Abstract

ObjectiveThis study examined the effectiveness of neuromuscular electrical stimulation (NMES) added to the exercise or superimposed on voluntary contractions on patient‐reported outcomes measures (PROMs) in people with knee osteoarthritis (OA).MethodsThis systematic review was described according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Randomized controlled trials (RCTs) were obtained from a systematic literature search in five electronic databases (PubMed, PEDro, LILACS, EMBASE, and SPORTDiscus) in April 2022. We described the effects of intervention according to each PROMs (scores for Pain; Self‐reported functional ability; Symptoms (hear clicking, swelling, catching, restricted range of motion, and stiffness); Daily living function; Sports function; and Quality of life) and used a random‐effect model to examine the impact of NMES plus exercise on pain compared with exercise in people with knee OA.ResultsSix RCTs (n = 367) were included. In the qualitative synthesis, the systematic literature analysis showed improvement in pain after NMES plus exercise compared with exercise alone in three studies. The other three studies revealed no difference between groups in pain, although similar improvement after treatments. In the meta‐analysis, NMES at a specific joint angle combined with exercise was not superior to exercise alone in pain management (standardized mean difference = −0.33, 95% CI = −1.05 to 0.39, p = 0.37). There was no additional effect of NMES on exercise on self‐reported functional ability, stiffness, and physical function compared with exercise alone. In only one study, symptoms, activities of daily living, sports function, and quality of life improved after whole‐body electrostimulation combined with exercise.ConclusionThis review found insufficient evidence for the effectiveness of NMES combined with exercise in treating knee OA considering PROMs. While pain relief was observed in some studies, more high‐quality clinical trials are needed to support the use of NMES added to the exercise in clinical practice. Electrical stimulation in a whole‐body configuration combined with exercise shows promise as an alternative treatment option.

Effects of Whole-body Electromyostimulation on knee pain and physical function in adults with symptomatic knee osteoarthritis: a randomized controlled trial

“…All other studies that have investigated the effect of EMSmostly the term neuromuscular electrical stimulation (NMES) is used in literaturein knee OA have only used a local stimulation. The results of two recent meta-analysis on the effect of local EMS in individuals with knee OA indicate an increase in quadriceps muscle strength [52], but no significant reduction in pain [21,52].…”

“…A systematic review by de Oliveira et al [20] showed moderate evidence in favour of neuromuscular electrical stimulation (NMES) alone or in combination with exercise for isometric quadriceps strengthening. A recent meta-analysis by Carvalho et al [21] reported insufficient evidence on the effects of NMES combined with exercise compared to exercise alone on patient-reported outcomes (e.g. pain).…”