BACKGROUND: Osteoarthritis is the most common form of joint disease and theleading cause of pain and physical disability in the elderly. Transcutaneouselectrical nerve stimulation (TENS), interferential current stimulation andpulsed electrostimulation are used widely to control both acute and chronic pain arising from several conditions, but some policy makers regard efficacy evidence as insufficient.OBJECTIVES: To compare transcutaneous electrostimulation with sham or no specificintervention in terms of effects on pain and withdrawals due to adverse events inpatients with knee osteoarthritis.SEARCH STRATEGY: We updated the search in CENTRAL, MEDLINE, EMBASE, CINAHL andPEDro up to 5 August 2008, checked conference proceedings and reference lists,and contacted authors.SELECTION CRITERIA: Randomised or quasi-randomised controlled trials thatcompared transcutaneously applied electrostimulation with a sham intervention or no intervention in patients with osteoarthritis of the knee.DATA COLLECTION AND ANALYSIS: We extracted data using standardised forms andcontacted investigators to obtain missing outcome information. Main outcomes werepain and withdrawals or dropouts due to adverse events. We calculatedstandardised mean differences (SMDs) for pain and relative risks for safetyoutcomes and used inverse-variance random-effects meta-analysis. The analysis of pain was based on predicted estimates from meta-regression using the standarderror as explanatory variable.MAIN RESULTS: In this update we identified 14 additional trials resulting in the inclusion of 18 small trials in 813 patients. Eleven trials used TENS, fourinterferential current stimulation, one both TENS and interferential currentstimulation, and two pulsed electrostimulation. The methodological quality andthe quality of reporting was poor and a high degree of heterogeneity among thetrials (I(2) = 80%) was revealed. The funnel plot for pain was asymmetrical (P < 0.001). The predicted SMD of pain intensity in trials as large as the largesttrial was -0.07 (95% CI -0.46 to 0.32), corresponding to a difference in painscores between electrostimulation and control of 0.2 cm on a 10 cm visualanalogue scale. There was little evidence that SMDs differed on the type ofelectrostimulation (P = 0.94). The relative risk of being withdrawn or droppingout due to adverse events was 0.97 (95% CI 0.2 to 6.0).AUTHORS' CONCLUSIONS: In this update, we could not confirm that transcutaneouselectrostimulation is effective for pain relief. The current systematic review isinconclusive, hampered by the inclusion of only small trials of questionablequality. Appropriately designed trials of adequate power are warranted.
Transcutaneous electrostimulation for osteoarthritis of the knee
Rutjes, Anne;
2009-01-01
Abstract
BACKGROUND: Osteoarthritis is the most common form of joint disease and theleading cause of pain and physical disability in the elderly. Transcutaneouselectrical nerve stimulation (TENS), interferential current stimulation andpulsed electrostimulation are used widely to control both acute and chronic pain arising from several conditions, but some policy makers regard efficacy evidence as insufficient.OBJECTIVES: To compare transcutaneous electrostimulation with sham or no specificintervention in terms of effects on pain and withdrawals due to adverse events inpatients with knee osteoarthritis.SEARCH STRATEGY: We updated the search in CENTRAL, MEDLINE, EMBASE, CINAHL andPEDro up to 5 August 2008, checked conference proceedings and reference lists,and contacted authors.SELECTION CRITERIA: Randomised or quasi-randomised controlled trials thatcompared transcutaneously applied electrostimulation with a sham intervention or no intervention in patients with osteoarthritis of the knee.DATA COLLECTION AND ANALYSIS: We extracted data using standardised forms andcontacted investigators to obtain missing outcome information. Main outcomes werepain and withdrawals or dropouts due to adverse events. We calculatedstandardised mean differences (SMDs) for pain and relative risks for safetyoutcomes and used inverse-variance random-effects meta-analysis. The analysis of pain was based on predicted estimates from meta-regression using the standarderror as explanatory variable.MAIN RESULTS: In this update we identified 14 additional trials resulting in the inclusion of 18 small trials in 813 patients. Eleven trials used TENS, fourinterferential current stimulation, one both TENS and interferential currentstimulation, and two pulsed electrostimulation. The methodological quality andthe quality of reporting was poor and a high degree of heterogeneity among thetrials (I(2) = 80%) was revealed. The funnel plot for pain was asymmetrical (P < 0.001). The predicted SMD of pain intensity in trials as large as the largesttrial was -0.07 (95% CI -0.46 to 0.32), corresponding to a difference in painscores between electrostimulation and control of 0.2 cm on a 10 cm visualanalogue scale. There was little evidence that SMDs differed on the type ofelectrostimulation (P = 0.94). The relative risk of being withdrawn or droppingout due to adverse events was 0.97 (95% CI 0.2 to 6.0).AUTHORS' CONCLUSIONS: In this update, we could not confirm that transcutaneouselectrostimulation is effective for pain relief. The current systematic review isinconclusive, hampered by the inclusion of only small trials of questionablequality. Appropriately designed trials of adequate power are warranted.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
