Using TENS to Enhance Therapeutic Exercise in Individuals with Knee Osteoarthritis

• Published in: Medicine and science in sports and exercise 2020-10, Vol.52 (10), p.2086-2095
• Main Authors: PIETROSIMONE, BRIAN, LUC-HARKEY, BRITTNEY A., HARKEY, MATTHEW S., DAVIS-WILSON, HOPE C., PFEIFFER, STEVEN J., SCHWARTZ, TODD A., NISSMAN, DANIEL, PADUA, DARIN A., BLACKBURN, J TROY, SPANG, JEFFERY T.
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Adult; Aged; Double-Blind Method; Exercise Test - methods; Exercise Therapy; Female; Humans; Male; Middle Aged; Muscle Strength; Osteoarthritis, Knee - physiopathology; Osteoarthritis, Knee - rehabilitation; Patient Reported Outcome Measures; Physical Functional Performance; Quadriceps Muscle - physiology; Transcutaneous Electric Nerve Stimulation; Walking Speed
• ISSN: 0195-9131; 1530-0315
• DOI: 10.1249/MSS.0000000000002353

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). PURPOSEThis study aimed to determine the effect of TENS + TE on patient-reported function, quadriceps strength, and voluntary activation, as well as physical performance compared with sham TENS + TE (Sham) and TE alone in individuals with symptomatic KOA and QVAF. METHODSNinety individuals participated in a double-blinded randomized controlled trial. Everyone received 10 standardized TE sessions of physical therapy. TENS + TE and Sham groups applied the respective devices during all TE sessions and throughout activities of daily living over 4 wk. The Western Ontario and McMaster University Osteoarthritis Index (WOMAC), quadriceps strength, and voluntary activation, as well as a 20-m walk test, chair-stand test, and stair-climb test were performed at baseline, after the 4-wk intervention (post 1) and at 8 wk after 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. RESULTSImprovements in WOMAC subscales, quadriceps strength, and voluntary activation, 20-m walk times, chair-stand repetitions, and stair-climb time were found at post 1 and post 2 compared with baseline for all groups (P < 0.05). WOMAC Pain and Stiffness improved in the TENS + TE group compared with TE alone at post 1 (P < 0.05); yet, no other between-group differences were found. CONCLUSIONSTE 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.