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Lee JH, Lee GB, Chung WY, Wang JW, Jang KM. Stair-Climbing Training with Interferential Electrotherapy Improves Knee Muscle Strength, Dynamic Postural Stability, Pain Score, and Physical Activity in Patients with Knee Osteoarthritis. Diagnostics (Basel) 2024; 14:2060. [PMID: 39335739 PMCID: PMC11431365 DOI: 10.3390/diagnostics14182060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 08/17/2024] [Accepted: 09/12/2024] [Indexed: 09/30/2024] Open
Abstract
Background/Objective: This study aimed to compare the functional outcomes, such as knee muscle strength, dynamic postural stability, pain scores, and physical activity, in patients with knee osteoarthritis (OA) on stair climbing training with and without interferential electrotherapy (IFE) for 12 weeks. Methods: A total of 40 knee OA patients with Kellgren-Lawrence (K-L) grade ≤ 2 were enrolled (20 stair-climbing training with IFE vs. 20 stair-climbing training without IFE). The knee quadriceps and hamstring muscle strengths were measured using an isokinetic device. The dynamic postural stability was assessed using postural stabilometry. The pain score was evaluated using the visual analog scale (VAS). Physical activity was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results: The WOMAC score was significantly different (p < 0.019) between stair-climbing training with and without IFE in patients with knee OA, while knee muscle strength, dynamic postural stability, or pain score were not (all p > 0.05). Conclusion: Stair-climbing training with IFE was more beneficial for physical activity recovery than stair-climbing training without IFE. Therefore, clinicians and therapists should be aware that stair climbing, which can be practiced in daily life for the management of patients with knee OA, and the addition of IFE may improve physical activity.
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Affiliation(s)
- Jin Hyuck Lee
- Department of Sports Medical Center, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Gyu Bin Lee
- Department of Sports Medical Center, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Woo Yong Chung
- Department of Sports Medical Center, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Ji Won Wang
- Department of Sports Medical Center, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Ki-Mo Jang
- Department of Sports Medical Center, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
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Varapirom C, Kuptniratsaikul V, Yamthed R, Srisomnuek A. Efficacy of interferential current therapy plus exercise compared to sham interferential current plus exercise for pain relief in patients with knee osteoarthritis: A randomised controlled trial. Clin Rehabil 2024:2692155241278949. [PMID: 39257067 DOI: 10.1177/02692155241278949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
OBJECTIVE To compare the efficacy of interferential current (IFC) therapy combined with quadriceps strengthening exercise versus sham IFC plus exercise for pain relief and functional improvement in patients with knee osteoarthritis. STUDY DESIGN Double-blind randomised controlled trial. SETTING Outpatient rehabilitation clinic. SUBJECTS Knee osteoarthritis patients aged 50-85 years with a pain score ≥4/10. METHODS One hundred forty-four participants were randomly allocated into the study and control groups. The study group received 20 min of IFC therapy (carrier frequency: 4000 Hz, beat frequency: 100 Hz) five times per week for three weeks, while the control group received sham IFC following the same protocol, followed by 10 min of exercise in both groups. Outcome measures included Numeric Rating Scale for Pain, Western Ontario and McMaster Universities Index (WOMAC) score, gait speed, and EuroQol-Five Dimensions-Five Levels questionnaire assessed at baseline, Week 3, and Week 6. Adverse events and patient satisfaction were evaluated at Week 3. RESULTS At Week 3, the study group demonstrated statistical improvement compared to the control group for Numeric Rating Scale for Pain, WOMAC Total, WOMAC Pain, and WOMAC Stiffness. The mean difference (95% confidence interval) between groups was 0.76 (0.21-1.30), 0.49 (0.03-0.95), 0.63 (0.13-1.13), and 0.62 (0.04-1.20), respectively. However, the mean differences between groups were below the Minimally Clinically Important Difference values for each outcome. Additionally, there were no significant differences between groups at Week 6 for any outcome measure. CONCLUSION IFC had no effect on pain reduction and functional improvement in patients with mild to moderate knee osteoarthritis.
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Affiliation(s)
- Chalida Varapirom
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Vilai Kuptniratsaikul
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rungsima Yamthed
- Division of Physical Therapy, Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ananya Srisomnuek
- Research Group and Research Network Division, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Menezes MA, Mendonça Araújo F, Lima LV, Souza TAS, Carvalho EAN, Melo DeSantana J. Interferential current intensity influences the hypoalgesic response in healthy subjects under mechanically-induced pain: A randomized controlled trial. Physiother Theory Pract 2023; 39:2087-2098. [PMID: 35505631 DOI: 10.1080/09593985.2022.2068095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 04/12/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Interferential current (IFC) is a non-pharmacological therapy often used to reduce pain intensity. However, there is no scientific evidence of the biological effects of the adjustment of IFC intensity of stimulation. OBJECTIVE To investigate whether the adjustment of IFC intensity influences pain on cutaneous sensory threshold (CST), pressure pain threshold (PPT) and pain intensity in healthy subjects under mechanically induced pain. METHODS This is a placebo-controlled randomized trial. One hundred and two healthy university students blinded to intervention were randomized using opaque sealed envelopes to the following groups: 1) sensory IFC (n = 24); 2) fixed motor IFC (n = 26); 3) adjusted motor IFC (n = 27); and 4) placebo IFC (n = 25). After 40 minutes of stimulation or placebo, subjects were evaluated by an investigator blinded to group allocation. CST (von Frey filaments), PPT (algometry), and pain intensity (11-point numerical scale) were measured. RESULTS Adjusted motor IFC promoted a significant reduction of CST (hand: mean difference (MD) = 2.39, confidence intervals (CI) = 1.39-3.38; and forearm: MD = 3.01, CI = 2.87-3.14) compared to placebo. Adjusted motor IFC increased PPT significantly (hand: MD = 27.59, CI = 26.80-28.37; and forearm: MD = 34, CI = 25.74-42.25) when compared to placebo. Adjusted motor IFC reduced pain intensity by 4.01 points (CI = 3.64-4.55) when compared to placebo. No adverse events were observed. CONCLUSIONS Adjusted motor IFC intensity increased PPT and CST and also reduced pain intensity in healthy subjects under mechanically induced pain.
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Affiliation(s)
- Mayara Alves Menezes
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Fernanda Mendonça Araújo
- Physiological Sciences Graduate Program, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Lucas Vasconcelos Lima
- Department of Psychology, McGill University, 2001 Avenue McGill College, Montreal, QC, Canada
| | | | - Elyson Adan Nunes Carvalho
- Department of Electrical Engineering, Graduate Program in Electrical Engineering, Federal University of Sergipe, São Cristóvão, Brazil
| | - Josimari Melo DeSantana
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Physiological Sciences Graduate Program, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
- Department of Physical Therapy, Federal University of Sergipe, Brazil
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Effect of different electrostimulation currents on female urinary incontinence: A protocol of a randomized controlled trial. PLoS One 2022; 17:e0276722. [PMID: 36454970 PMCID: PMC9714840 DOI: 10.1371/journal.pone.0276722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/28/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Urgency urinary incontinence (UUI) is characterized by involuntary urine leakage immediately after reporting of sudden, compelling desire to void. Electrostimulation and non-invasive neuromodulation have been considered as the first and third line of UUI treatment but there is a lack of consensus on which parameters are more efficient. Thus, this study aims to compare the effect of low versus medium frequency currents on urinary incontinence severity and quality of life in women with UUI complains. METHODS It will be a randomized controlled trial with 5 arms, double-blinded (outcome assessor and statistician). The study was approved by the Research Ethics Committee (CAAE: 11479119.9.0000.5406) and has been prospectively registered on the Brazilian Registry of Clinical Trials (RBR-8bkkp6). Concerning, double-blind process, the blinded assessor will be responsible for evaluate primary and secondary outcomes at baseline and follow-up without information about allocation and the statistician will perform analyses without information about group codification. One hundred and five participants will be randomized to receive: (1) Transcutaneous tibial nerve stimulation-low frequency, (2) Transcutaneous tibial nerve stimulation-high frequency, (3) Aussie median frequency, (4) Interferencial median frequency or (5) High voltage stimulation. The application will be performed during 20 sessions of 45-minutes, twice a week for 10 weeks, in groups of maximum 5 participants. The participants will be evaluated before treatment (baseline- 0 week), during the treatment (5 weeks) and after the last treatment session (10 weeks). The primary outcomes measures will be UI severity and quality of life, and the secondary outcome will be pelvic floor strength. Statistical analysis will be performed using SPSS software version 24.0 for Windows (IBM Corp., Armonk, N.Y., USA). The variables will be described by the mean and 95% confidence interval. The distribution of normality will be analyzed by the Shapiro-Wilk test. ANOVA for repeated measures will be performed. Mauchly's test the hypothesis of sphericity and when if this violated the hypotheses, the analyses will be based on the Greenhouse-Geisser test. Peer-to-peer comparisons will be performed using the Bonferroni Post-Hoc test. The significant level adopted will be 5% (p ≤ 0.05). CONCLUSION This study will enhance knowledge about effect of different neuromodulation currents in the improvement of UUI.
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Hussein HM, Alshammari RS, Al-Barak SS, Alshammari ND, Alajlan SN, Althomali OW. A Systematic Review and Meta-analysis Investigating the Pain-Relieving Effect of Interferential Current on Musculoskeletal Pain. Am J Phys Med Rehabil 2022; 101:624-633. [PMID: 34469914 DOI: 10.1097/phm.0000000000001870] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Interferential current is one of the most common electrotherapeutic modalities used in the treatment of painful conditions. Patients seeking medical help to reduce their musculoskeletal pain can be treated using interferential current. OBJECTIVE The current review aimed to analyze the recently available information regarding the efficacy of interferential current in alleviating the pain of musculoskeletal origin. METHODS This study used Scopus, CINAHL, Cochrane Library, Web of Science, MEDLINE, Embase, and EBSCOas as data sources. The initial selection of the studies, thorough assessment of the full articles, and extraction of the necessary study characteristics were carried out by two independent reviewers. Another two independent reviewers assessed the methodological quality of each included trial against 39 criteria. These criteria were integrated from several popular scales. Pain intensity-measured using the visual analog scale, numeric pain rating scale, or McGill Pain Questionnaire-was the outcome of interest. RESULTS This review included 35 trials of variable methodological quality from which 19 trials were selected for the meta-analysis. In general, interferential current alone versus placebo demonstrated a significant pain-relieving effect. On the other hand, interferential current showed no significant difference when added to standard treatment compared with placebo plus standard treatment or standard treatment alone. Similarly, interferential current showed no significant difference when compared with other single interventions (laser, transcutaneous electrical nerve stimulation, cryotherapy). CONCLUSIONS Interferential current alone is better than placebo at discharge. However, the low number of studies raises suspicions about this conclusion. Interferential current alone or added to other interventions is not more effective than comparative treatments in relieving musculoskeletal pain.
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Affiliation(s)
- Hisham M Hussein
- From the Department of Physical Therapy, College of Applied Medical Sciences, University of Hail, Ha'il, Saudi Arabia (HMH, RSA, SSA-B, NDA, SNA, OWA); and Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt (HMH)
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Effectiveness of interferential current therapy in patients with knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Sci Rep 2022; 12:9694. [PMID: 35690604 PMCID: PMC9188606 DOI: 10.1038/s41598-022-13478-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 05/25/2022] [Indexed: 11/08/2022] Open
Abstract
We conducted a systematic review and meta-analysis to assess the effectiveness of interferential current therapy (IFC) in patients with knee osteoarthritis. We searched PubMed, Cochrane Library, Embase, ClinicalKey, and Scopus for relevant studies from their date of launch to March 22, 2022. We included randomized controlled trials (RCTs) in which IFC was applied to knee osteoarthritis patients and the outcomes of pain scores or functional scales were assessed. Ten RCTs with 493 patients met the inclusion criteria. Nine RCTs were included in the meta-analysis. The IFC groups exhibited significant improvements relative to the control groups for short-term pain scores (SMD = - 0.64, 95% CI - 1.04 to - 0.25, P = 0.001), long-term pain scores (SMD = - 0.36, 95% CI - 0.60 to - 0.11, P = 0.005), and short-term Western Ontario and McMaster Universities Osteoarthritis Index scores (SMD = - 0.39, 95% CI - 0.77 to - 0.02, P = 0.04). All included studies did not observe any obvious adverse effects of IFC. IFC can be recommended as a treatment for knee osteoarthritis because it improves short- and long-term pain and short-term function. However, large-scale and high-quality RCTs with longer follow-up are required to establish an appropriate standardized treatment.
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It Hurts to Move! Intervention Effects and Assessment Methods for Movement-Evoked Pain in Patients With Musculoskeletal Pain: A Systematic Review with Meta-analysis. J Orthop Sports Phys Ther 2022; 52:345-374. [PMID: 35128943 DOI: 10.2519/jospt.2022.10527] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To estimate the effects of musculoskeletal rehabilitation interventions on movementevoked pain and to explore the assessment methods/protocols used to evaluate movement-evoked pain in adults with musculoskeletal pain. DESIGN Systematic review with meta-analysis. LITERATURE SEARCH Three electronic databases (PubMed, Web of Science, and Scopus) were searched. STUDY SELECTION CRITERIA Randomized controlled trials investigating musculoskeletal rehabilitation interventions for movement-evoked pain in adults with musculoskeletal pain were included. DATA SYNTHESIS Meta-analysis was conducted for outcomes with homogeneous data from at least 2 trials. The mean change in movementevoked pain was the primary outcome measure. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. RESULTS Thirty-eight trials were included, and 60 different interventions were assessed. There was moderate-certainty evidence of a beneficial effect of exercise therapy compared to no treatment (standardized mean difference [SMD], -0.65; 95% confidence interval [CI]: -0.83, -0.47; P<.001) on movement-evoked pain in adults with musculoskeletal pain. There was low-certainty evidence of a beneficial effect of transcutaneous electrical nerve stimulation compared to no treatment (SMD, -0.46; 95% CI: -0.71, -0.21; P = .0004). There was no benefit of transcutaneous electrical nerve stimulation when compared to sham transcutaneous electrical nerve stimulation (SMD, -0.28; 95% CI: -0.60, 0.05; P = .09; moderate-certainty evidence). CONCLUSION There was moderate-certainty evidence that exercise therapy is effective for reducing movement-evoked pain in patients with musculoskeletal pain compared to no treatment. Consider exercise therapy as the first-choice treatment for movement-evoked pain in clinical practice. J Orthop Sports Phys Ther 2022;52(6):345-374. Epub: 05 Feb 2022. doi:10.2519/jospt.2022.10527.
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Rampazo ÉP, Liebano RE. Analgesic Effects of Interferential Current Therapy: A Narrative Review. Medicina (B Aires) 2022; 58:medicina58010141. [PMID: 35056448 PMCID: PMC8779694 DOI: 10.3390/medicina58010141] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 12/26/2022] Open
Abstract
Background and Objectives: Transcutaneous electrical stimulation of low- and medium-frequency currents is commonly used in pain management. Interferential current (IFC) therapy, a medium frequency alternating current therapy that reportedly reduces skin impedance, can reach deeper tissues. IFC therapy can provide several different treatment possibilities by adjusting its parameters (carrier frequency, amplitudemodulated frequency, sweep frequency, sweep mode or swing pattern, type of application (bipolar or quadripolar), time of application and intensity). The objective of this review article is to discuss the literature findings on the analgesic efficacy of IFC therapy. Conclusions: According to the literature, IFC therapy shows significant analgesic effects in patients with neck pain, low back pain, knee osteoarthritis and post-operative knee pain. Most of the IFC parameters seem not to influence its analgesic effects. We encourage further studies to investigate the mechanism of action of IFC therapy.
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ALMEIDA NICOLE, PALADINI LUISHENRIQUE, DIAS LUCASVINICIUS, SALES RAMONSCHMIDTDE, MACEDO ANACAROLINABRANDTDE. IMMEDIATE ANALGESIC EFFECT OF 4KHZ AMFS INTERFERENTIAL CURRENT ON CHRONIC LOW BACK PAIN. COLUNA/COLUMNA 2022. [DOI: 10.1590/s1808-185120222102253908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: To analyze the immediate effect of amplitude modulation frequencies (AMFs) of 4kHz interferential current (IFC) on chronic low back pain (CLBP). Method: This is a randomized controlled clinical trial. Sixty-three subjects with CLBP were recruited. The subjects were randomized into 3 groups: the placebo group (PG, n=21) and 2 intervention groups (IG), IG4kHz/2Hz (n=21) and IG4kHz/100Hz (n=21). All groups were submitted to a single session of 30 minutes. Pain was evaluated using a numerical rating scale (NRS), the McGill Pain Questionnaire (MPQ), and pressure algometry. Flexibility was evaluated using the Modified Schober Test (MST), the Sit-and-Reach Test (SRT), the Fingertip-to-Floor Test (FTF), and the Passive Straight-Leg Raise Test (PSLR). Results: Comparing IG4kHz/100Hz with PG, we found a significant difference (p<0.05) in NRS in the total and in the MPQ categories, whereas in the comparison between IG4kHz/2Hz and PG, we found a significant difference only in the sensory and evaluative categories of MPQ. Regarding the flexibility tests, we observed a significant difference of both IG4kHz/100Hz and IG4kHz/2Hz in comparison to PG in MST and PSLR, and of IG4kHz/2Hz in comparison to PG in SRT. The 4kHz IFC was effective in immediately reducing CLBP and, consequently, in increasing the flexibility of the lumbar spine and lower limbs. Conclusion: Conclusion: There was a greater number of significant positive outcomes when the 100Hz AMF was adopted. Level of Evidence I; High quality randomized clinical trial with or without statistically significant differences, but with narrow confidence intervals.
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Alqualo-Costa R, Rampazo ÉP, Thome GR, Perracini MR, Liebano RE. Interferential current and photobiomodulation in knee osteoarthritis: A randomized, placebo-controlled, double-blind clinical trial. Clin Rehabil 2021; 35:1413-1427. [PMID: 33896234 DOI: 10.1177/02692155211012004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To evaluate the effects of interferential current and photobiomodulation in patients with knee osteoarthritis. DESIGN A randomized, placebo-controlled, double-blind clinical trial. SETTING Physiotherapy Clinic of City University of São Paulo. SUBJECTS A total of 184 patients with knee osteoarthritis were recruited and, of these, 168 were included and randomized into four groups with 42 each: interferential current, photobiomodulation, interferential current plus photobiomodulation or placebo groups. One hundred and sixty-four patients completed the study. INTERVENTION Patients received 12 sessions (three times a week) of treatment: 30 minutes of interferential current (active or placebo) followed by photobiomodulation (active or placebo). MAIN MEASURES Primary outcome: pain intensity at rest and during movement (numeric rating scale) after 12 sessions. Secondary outcomes: functional capacity (Timed Up & Go and Sit and Lift tests and Lequesne and WOMAC questionnaires), pressure pain threshold, conditioned pain modulation, and muscle strength production (isokinetic evaluation). Patients were assessed at baseline, after 12 sessions, and three and six months after the end of the treatment. RESULTS Interferential current plus photobiomodulation reduced pain intensity at rest and during movement compared to placebo and interferential current at all time points (P < 0.05). Photobiomodulation reduced pain intensity at rest compared to placebo at all time points (P < 0.05) and compared to interferential current at six months follow-up (P < 0.05). Photobiomodulation reduced pain intensity during movement compared to placebo at six months follow-up (P < 0.05). CONCLUSION Interferential current plus photobiomodulation or isolated photobiomodulation improve pain intensity in knee osteoarthritis.
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Affiliation(s)
- Renata Alqualo-Costa
- Master's and Doctoral Programs in Physical Therapy, City University of São Paulo (UNICID), São Paulo, São Paulo, Brazil
| | - Érika Patrícia Rampazo
- Physioterapeutics Resources Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Gustavo Ribeiro Thome
- Master's and Doctoral Programs in Physical Therapy, City University of São Paulo (UNICID), São Paulo, São Paulo, Brazil
| | - Mônica Rodrigues Perracini
- Master's and Doctoral Programs in Physical Therapy, City University of São Paulo (UNICID), São Paulo, São Paulo, Brazil
| | - Richard Eloin Liebano
- Physioterapeutics Resources Laboratory, Department of Physical Therapy, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
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Hahm SC, Lee JS, Yoon YW, Kim J. Analgesic Tolerance Development during Repetitive Electric Stimulations Is Associated with Changes in the Expression of Activated Microglia in Rats with Osteoarthritis. Biomedicines 2020; 8:biomedicines8120575. [PMID: 33297333 PMCID: PMC7762208 DOI: 10.3390/biomedicines8120575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/01/2020] [Accepted: 12/05/2020] [Indexed: 11/30/2022] Open
Abstract
Electric stimulation is used for managing osteoarthritic (OA) pain; however, little is known about the development of analgesic tolerance during repeated stimulations and the relation of spinal microglia with OA pain. We investigated the changes in the analgesic effects of repeated electric stimulations and the relation between the development of analgesic tolerance and spinal microglial expression in rats with OA. To induce OA, monosodium iodoacetate was injected into the synovial space of the right knee joint of the rats (n = 185). Repeated high frequency, low frequency, or sham transcutaneous electric nerve stimulation (TENS) was performed to the ipsilateral knee joint for 20 min in rats with OA (n = 45). Minocycline or minocycline plus TENS (HF, LF, or sham) was treated in OA rats with repeated TENS-induced tolerance (n = 135). Immunohistochemistry of the microglia in the L3–L5 spinal segments was performed. Knee joint pain during passive movement of the knee joint were quantified using the knee-bend score and the proportion of activated microglia was calculated as primary variables. Paw withdrawal threshold (hypersensitivity to mechanical stimuli) was assessed and the resting and activated microglia were counted as secondary variables. Repeated applications decreased the analgesic effect of TENS on OA pain and failed to reduce the expression of activated microglia in the spinal cord. However, spinal microglial inhibition by minocycline restored the analgesic effect of TENS on OA pain in TENS-tolerant OA rats. TENS combined with minocycline treatment improved knee joint pain and mechanical hypersensitivity in TENS-tolerant OA rats, and inhibited the expression of activated microglia in the spinal cord. These results suggest a possible relationship between repetitive electric stimulation-induced analgesic tolerance for OA pain control and changes in microglia activation.
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Affiliation(s)
- Suk-Chan Hahm
- Graduate School of Integrative Medicine, CHA University, Seongnam 13488, Korea;
| | - Jin Seung Lee
- Department of Physical Therapy, Korea University College of Health Science, Seoul 02841, Korea;
- Rehabilitation Science Program, Department of Health Sciences, Graduate School, Korea University, Seoul 02841, Korea
- BK21FOUR R&E Center for Learning Health Systems, Korea University, Seoul 02841, Korea
| | - Young Wook Yoon
- Department of Physiology, Korea University College of Medicine, Seoul 02841, Korea;
| | - Junesun Kim
- Department of Physical Therapy, Korea University College of Health Science, Seoul 02841, Korea;
- Rehabilitation Science Program, Department of Health Sciences, Graduate School, Korea University, Seoul 02841, Korea
- BK21FOUR R&E Center for Learning Health Systems, Korea University, Seoul 02841, Korea
- Correspondence: ; Tel.: +82-2-3290-5689; Fax: +82-2-921-7260
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Almeida N, Paladini LH, Korelo RG, Liebano RE, de Macedo ACB. Immediate Effects of the Combination of Interferential Therapy Parameters on Chronic Low Back Pain: A Randomized Controlled Trial. Pain Pract 2020; 20:615-625. [PMID: 32219973 DOI: 10.1111/papr.12888] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/12/2020] [Accepted: 03/17/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To compare the immediate analgesic effects of 2 kHz or 4 kHz interferential current (IFC) with different amplitude-modulated frequencies (AMFs) (2 Hz or 100 Hz) on chronic low back pain (CLBP). DESIGN Three-arm double-blinded randomized controlled trial. SETTING Primary care. PARTICIPANTS 175 patients (19 to 60 years of age, 105 female) with CLBP. INTERVENTIONS One session of IFC: Interferential group (GI): GI2 kHz/100 Hz, GI2 kHz/2 Hz, GI4 kHz/100 Hz, GI4 kHz/2 Hz, or placebo. MAIN OUTCOMES MEASURES Pain intensity by numerical rating scale of pain (NRS), McGill Pain Questionnaire (MPQ), and algometry. RESULTS There was a significant difference in NRS scores (P < 0.05) in the GI2 kHz/2 Hz, GI4 kHz/2 Hz, and GI4 kHz/100 Hz groups compared with those of the placebo group (PG), and a significant difference in MPQ scores in the GI4 kHz/2 Hz and GI4 kHz/100 Hz groups compared with those of the PG. In algometry, only the GI4 kHz/100 Hz group showed a significant difference (by 2 points in the lumbar region) compared with the PG. Of the carrier frequencies, an IFC of 4 kHz showed more effective results, although no significant difference was noted between the AMFs. CONCLUSION An IFC with a carrier frequency of 4 kHz and an AMF of 100 Hz provide immediate analgesic effects in individuals with CLBP. CLINICAL TRIAL REGISTRATION NUMBER RBR-59YGRB.
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Affiliation(s)
- Nicole Almeida
- Department of Prevention and Rehabilitation in Physiotherapy, Universidade Federal do Paraná, Curitiba, Brazil
| | - Luis Henrique Paladini
- Department of Prevention and Rehabilitation in Physiotherapy, Universidade Federal do Paraná, Curitiba, Brazil
| | | | - Richard E Liebano
- Physiotherapy Department, Universidade Federal de São Carlos, São Carlos, Brazil
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de Paula Gomes CAF, Politti F, de Souza Bacelar Pereira C, da Silva ACB, Dibai-Filho AV, de Oliveira AR, Biasotto-Gonzalez DA. Exercise program combined with electrophysical modalities in subjects with knee osteoarthritis: a randomised, placebo-controlled clinical trial. BMC Musculoskelet Disord 2020; 21:258. [PMID: 32312265 PMCID: PMC7171730 DOI: 10.1186/s12891-020-03293-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 04/15/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND It is not yet clear which of the various electrophysical modalities used in clinical practice is the one that contributes most positively when added to an exercise program in patients with knee osteoarthritis (OA). The aim of the present study was to analyze the clinical effects of the inclusion of interferential current therapy (ICT), shortwave diathermy therapy (SDT) and photobiomodulation (PHOTO) into an exercise program in patients with knee OA. METHODS This prospective, five-arm, randomised, placebo-controlled trial was carried out with blinded participants and examiners. We recruited 100 volunteers aged 40 to 80 years with knee OA. Participants were allocated into five groups: exercise, exercise + placebo, exercise + ICT, exercise + SDT, and exercise + PHOTO. The outcome measures included Western Ontario and McMaster Universities (WOMAC), numerical rating pain scale (NRPS), pressure pain threshold (PPT), self-perceived fatigue and sit-to-stand test (STST), which were evaluated before and after 24 treatment sessions at a frequency of three sessions per week. RESULTS In all groups, there was a significant improvement (p < 0.05) in all variables over time, except pressure pain threshold. We observed significant differences (p < 0.05) between the groups for WOMAC function (exercise vs. exercise + placebo, mean difference [MD] = 5.55, 95% confidence interval [CI] = 3.63 to 7.46; exercise vs. exercise + ICT, MD = 3.40, 95% CI = 1.46 to 5.33; exercise vs. exercise + SDT, MD = 4.75, 95% CI = 1.85 to 7.64; exercise vs. exercise + PHOTO, MD = 5.45, 95% CI = 3.12 to 7.77) and WOMAC pain, with better scores achieved by the exercise group. However, these differences were not clinically relevant when considering the minimum clinically important difference. CONCLUSION The addition of ICT, SDT or PHOTO into an exercise program for individuals with knee OA is not superior to exercise performed in isolation in terms of clinical benefit. clinicaltrials.gov: NCT02636764, registered on March 29, 2014.
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Affiliation(s)
- Cid André Fidelis de Paula Gomes
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University, Rua Vergueiro, 235/249, 2° Subsolo, Liberdade, São Paulo, SP, CEP 01504-001, Brazil
| | - Fabiano Politti
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University, Rua Vergueiro, 235/249, 2° Subsolo, Liberdade, São Paulo, SP, CEP 01504-001, Brazil
| | - Cheila de Souza Bacelar Pereira
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University, Rua Vergueiro, 235/249, 2° Subsolo, Liberdade, São Paulo, SP, CEP 01504-001, Brazil
| | - Aron Charles Barbosa da Silva
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University, Rua Vergueiro, 235/249, 2° Subsolo, Liberdade, São Paulo, SP, CEP 01504-001, Brazil.
| | - Almir Vieira Dibai-Filho
- Postgraduate Program in Physical Education, Federal University of Maranhão, São Luís, MA, Brazil
| | - Adriano Rodrigues de Oliveira
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University, Rua Vergueiro, 235/249, 2° Subsolo, Liberdade, São Paulo, SP, CEP 01504-001, Brazil
| | - Daniela Aparecida Biasotto-Gonzalez
- Postgraduate Program in Rehabilitation Sciences, Nove de Julho University, Rua Vergueiro, 235/249, 2° Subsolo, Liberdade, São Paulo, SP, CEP 01504-001, Brazil
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Vongsirinavarat M, Nilmart P, Somprasong S, Apinonkul B. Identification of knee osteoarthritis disability phenotypes regarding activity limitation: a cluster analysis. BMC Musculoskelet Disord 2020; 21:237. [PMID: 32284051 PMCID: PMC7155250 DOI: 10.1186/s12891-020-03260-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 04/02/2020] [Indexed: 12/19/2022] Open
Abstract
Background Studies have reported the subtypes of individuals with knee osteoarthritis (OA) attempting to cluster this heterogonous condition. Activity limitations are commonly used to set goals in knee OA management and better identify subgroups based on level of disability in this patient population. Therefore, the objective of this study was to identify those activity limitations which could classify the disability phenotypes of knee OA. The phenotypes were also validated by comparing impairments and participation restrictions. Methods Participants comprised individuals with symptomatic knee OA. They were interviewed and undertook physical examination according to a standard evaluation forms based on the International Classification of Functioning, Disability and Health (ICF) model. Cluster analysis was used to determine those activity limitations which could best classify the phenotypes of knee OA. To validate the clustered variables, comparisons and regression analysis were performed for the impairments consisting of pain intensity, passive range of motion and muscle strength, and the participation restrictions included the difficulty level of acquiring goods and services and community life. Results In all, 250 participants with symptomatic knee OA were enrolled in the study. Three activity limitations identified from data distribution and literature were used as the cluster variables, included the difficulty level of maintaining a standing position, timed stair climbing and 40-m self-paced walk test. The analysis showed four phenotypes of individuals with knee OA according to the levels of disability from no to severe level of disability. All parameters of impairment and participation restrictions significantly differed among phenotypes. Subgroups with greater disability experienced worse pain intensity, limited range of motion (ROM), muscle power and participation restriction levels. The variance accounted for of the subgroups were also greater than overall participants. Conclusion The results of this study emphasized the heterogeneous natures of knee OA. Three activity limitations identified could classify the individuals with symptomatic knee OA to homogeneous subgroups from no to severe level of disability. The management plan, based on these homogeneous subgroups of knee OA, could be designated by considering the levels of impairments and participation restrictions.
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Affiliation(s)
- Mantana Vongsirinavarat
- Faculty of Physical Therapy, Mahidol University, Putthamonthon, Nakhon Pathom, 73170, Thailand.
| | - Patcharin Nilmart
- Department of Physical Therapy, School of Allied Health Science, Walailak University, Nakhon Si Thammarat, Thailand
| | - Sirikarn Somprasong
- Faculty of Physical Therapy, Mahidol University, Putthamonthon, Nakhon Pathom, 73170, Thailand
| | - Benjawan Apinonkul
- Faculty of Physical Therapy, Mahidol University, Putthamonthon, Nakhon Pathom, 73170, Thailand
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Usman Z, Maharaj SS, Kaka B. Effects of combination therapy and infrared radiation on pain, physical function, and quality of life in subjects with knee osteoarthritis: A randomized controlled study. Hong Kong Physiother J 2019; 39:133-142. [PMID: 31889764 PMCID: PMC6900333 DOI: 10.1142/s1013702519500124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 12/30/2017] [Indexed: 11/29/2022] Open
Abstract
Background: Knee osteoarthritis (KOA) is a common degenerative articular disease that causes disability and poor quality of life (QoL) of the individuals. Electrotherapeutic agents such as therapeutic ultrasound (US), interferential current (IFC), and infrared radiation are used in the treatment. It is not clear which of these agents is the best in improving these variables. Objective: The study aimed to compare the effects of the combined application of US and IFC therapies and infrared radiation on pain, functional activities, and QoL in people with KOA. Methods: In a randomized controlled study, 60 participants were randomized into two groups, the combination therapy group (CTG) and the infrared radiation group (IRG). Each group received 15-min treatment three times per week for 12 weeks. The visual analog scale (VAS) was used to assess the pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for functional activities and the Short Form Health Survey questionnaire for QoL. Results: Participants in the CTG had a significant (p<0.05) reduction in pain and significant (p<0.05) improvement in functional activities and QoL compared to the IRG. Conclusion: The results of this study support the use of the combination of IFC and US therapies to reduce pain and improve function and QoL for KOA patients.
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Affiliation(s)
- Zubair Usman
- Department of Physiotherapy, Rasheed Shakoni Teaching Hospital, P.M.B. 7200, Dutse Jigawa State, Nigeria
| | - Sonill Sooknunan Maharaj
- Department of Physiotherapy, University of KwaZulu-Natal, Private Bag X 54001, Durban 4000, South Africa
| | - Bashir Kaka
- Department of Physiotherapy, University of KwaZulu-Natal, Private Bag X 54001, Durban 4000, South Africa.,Department of Physiotherapy, Faculty of Allied Health Sciences, Bayero University Kano, Kano State, Nigeria
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Kadı MR, Hepgüler S, Atamaz FC, Dede E, Aydoğdu S, Aktuglu K, Ozkayın N, Ozturk C. Is interferential current effective in the management of pain, range of motion, and edema following total knee arthroplasty surgery? A randomized double-blind controlled trial. Clin Rehabil 2019; 33:1027-1034. [PMID: 30764635 DOI: 10.1177/0269215519829856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate the effectiveness of interferential current implementation following total knee arthroplasty surgery. DESIGN Double-blind randomized controlled study. SETTING Orthopedics and traumatology in-patient clinic. PARTICIPANTS From an initial enrollment of 132 patients, 113 who met the study inclusion criteria were randomly separated into two groups: the interferential current group ( n = 57) and the sham current group ( n = 56). A total of 98 patients completed the study: 49 in the interferential current group and 49 in the sham group. INTERVENTION Patients in the interferential current group received interferential current treatment for 30 minutes, twice a day for five days postoperatively. For the patients in the sham interferential current treatment group, the same pads were applied to the patients for the same time periods but no electrical stimulation was applied. MAIN OUTCOME MEASURES Patients were assessed in respect of pain, range of motion (ROM), edema, and the amount of paracetamol used at baseline and on the 5th and 30th days after surgery. RESULTS No significant difference was determined between the groups in respect of pain, ROM, and edema at days 0, 5, and 30. At the end of the 5th day, the amount of paracetamol used was significantly lower in the interferential current group ( P < 0.05). CONCLUSION In this study, both groups showed significant improvements in pain, ROM, and edema with no significant difference between the groups. Although there was a significant difference in paracetamol intake of the two groups, this cannot be argued as showing the effectiveness of interferential current.
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Affiliation(s)
- Mehmet Resul Kadı
- 1 Department of Physical Medicine and Rehabilitation, School of Medicine, Ege University, Izmir, Turkey
| | - Simin Hepgüler
- 1 Department of Physical Medicine and Rehabilitation, School of Medicine, Ege University, Izmir, Turkey
| | - Funda Calıs Atamaz
- 1 Department of Physical Medicine and Rehabilitation, School of Medicine, Ege University, Izmir, Turkey
| | - Emine Dede
- 1 Department of Physical Medicine and Rehabilitation, School of Medicine, Ege University, Izmir, Turkey
| | - Semih Aydoğdu
- 2 Department of Orthopaedic Surgery, School of Medicine, Ege University, Izmir, Turkey
| | - Kemal Aktuglu
- 2 Department of Orthopaedic Surgery, School of Medicine, Ege University, Izmir, Turkey
| | - Nadir Ozkayın
- 2 Department of Orthopaedic Surgery, School of Medicine, Ege University, Izmir, Turkey
| | - Cihat Ozturk
- 1 Department of Physical Medicine and Rehabilitation, School of Medicine, Ege University, Izmir, Turkey
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de Paula Gomes CAF, Leal-Junior ECP, Dibai-Filho AV, de Oliveira AR, Bley AS, Biasotto-Gonzalez DA, de Tarso Camillo de Carvalho P. Incorporation of photobiomodulation therapy into a therapeutic exercise program for knee osteoarthritis: A placebo-controlled, randomized, clinical trial. Lasers Surg Med 2018; 50:819-828. [DOI: 10.1002/lsm.22939] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2018] [Indexed: 01/02/2023]
Affiliation(s)
| | - Ernesto C. P. Leal-Junior
- Laboratory of Phototherapy in Sports and Exercise; Postgraduate Program in Biophotonics Applied to Health Sciences; Nove de Julho University; São Paulo SP Brazil
| | - Almir V. Dibai-Filho
- Department of Physical Education; Federal University of Maranhão; São Luís MA Brazil
| | | | - André S. Bley
- Department of Physical Therapy; City of São Paulo University; São Paulo SP Brazil
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18
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Alqualo-Costa R, Thomé GR, Perracini MR, Liebano RE. Low-level laser therapy and interferential current in patients with knee osteoarthritis: a randomized controlled trial protocol. Pain Manag 2018; 8:157-166. [DOI: 10.2217/pmt-2017-0057] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The aim of this study is to investigate the effects of low-level laser therapy and interferential current (IFC) on pain intensity, central sensitization, muscle strength and functional capacity in patients with knee osteoarthritis. Participants will be patients aged between 50 and 80 years, with knee osteoarthritis, pain intensity ranging from 3 to 8 points (0–10 scale), Lequesne Algofunctional Index ranging from 5 to 15 points, and Kellgren & Lawrence grade ≥2. A total of 168 patients will be randomly allocated into four groups as follows: active IFC + laser sham (G1), IFC sham + active laser (G2), active IFC + laser (G3) and IFC + laser sham (G4). Evaluators will be blinded to group allocation. Primary outcomes will be pain at rest and during movement measured with the visual analog pain scale. Clinical Trials Registry (NCT02898025. Registered on 20 April 2016).
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Affiliation(s)
- Renata Alqualo-Costa
- Master's & Doctoral Programs in Physical Therapy, São Paulo City University (UNICID), 448/475 Cesário Galeno St., 03071-000, São Paulo, Brazil
| | - Gustavo R Thomé
- Master's & Doctoral Programs in Physical Therapy, São Paulo City University (UNICID), 448/475 Cesário Galeno St., 03071-000, São Paulo, Brazil
| | - Mônica R Perracini
- Master's & Doctoral Programs in Physical Therapy, São Paulo City University (UNICID), 448/475 Cesário Galeno St., 03071-000, São Paulo, Brazil
| | - Richard E Liebano
- Physical Therapy Department, São Carlos Federal University (UFSCar), Km 235 Rodovia Washington Luís, São Carlos 13565-905, São Paulo, Brazil
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19
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Gomes CAFDP, Dibai-Filho AV, Moreira WA, Rivas SQ, Silva EDS, Garrido ACB. Effect of Adding Interferential Current in an Exercise and Manual Therapy Program for Patients With Unilateral Shoulder Impingement Syndrome: A Randomized Clinical Trial. J Manipulative Physiol Ther 2018; 41:218-226. [DOI: 10.1016/j.jmpt.2017.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/26/2017] [Accepted: 09/26/2017] [Indexed: 11/29/2022]
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20
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Silva MTD, Araújo FM, Araújo MF, DeSantana JM. Effect of interferential current in patients with fibromyalgia: a systematic review. FISIOTERAPIA E PESQUISA 2018. [DOI: 10.1590/1809-2950/17276725012018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT High-intensity and widespread muscle pain is the main complaint of patients with fibromyalgia. Interferential current is a treatment often used in pain relief; however, its effects on these patients are unclear. The objective of this review was to analyze the effects of interferential current therapy on the treatment of patients with fibromyalgia in previously published scientific articles. We searched the following databases: Central, CINAHL, Lilacs, PEDro, Medline (PubMed), SciELO, Science Direct, Scopus and Web of Science on November 2016. We included only controlled clinical trials and had no restrictions for language and date of publication. We used the Cochrane Collaboration’s tool to assess the risk of bias of the articles. We found a total of 415 articles, however, only four of them were selected for analysis. Three of these studies were excluded because they were not controlled clinical trials. Thus, only one study was analyzed for this review. According to the study the combination of ultrasound and interferential current improved pain relief and the sleep quality of patients with fibromyalgia. However, the study presented a high risk of bias, being impossible to verify the isolated effect of the interferential current in those patients. Randomized controlled studies on the use of interferential current in patients with fibromyalgia are lacking on literature. The results of this review evidence the importance of developing future studies with adequate methodological design and using only interferential current therapy to improve the use of this therapy for these patients in this clinical setting.
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21
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Effect of Unmodulated 5-kHz Alternating Currents Versus Transcutaneous Electrical Nerve Stimulation on Mechanical and Thermal Pain, Tactile Threshold, and Peripheral Nerve Conduction: A Double-Blind, Placebo-Controlled Crossover Trial. Arch Phys Med Rehabil 2017; 98:888-895. [DOI: 10.1016/j.apmr.2016.11.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/14/2016] [Accepted: 11/17/2016] [Indexed: 11/21/2022]
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22
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Woods B, Manca A, Weatherly H, Saramago P, Sideris E, Giannopoulou C, Rice S, Corbett M, Vickers A, Bowes M, MacPherson H, Sculpher M. Cost-effectiveness of adjunct non-pharmacological interventions for osteoarthritis of the knee. PLoS One 2017; 12:e0172749. [PMID: 28267751 PMCID: PMC5340388 DOI: 10.1371/journal.pone.0172749] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 02/02/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is limited information on the costs and benefits of alternative adjunct non-pharmacological treatments for knee osteoarthritis and little guidance on which should be prioritised for commissioning within the NHS. This study estimates the costs and benefits of acupuncture, braces, heat treatment, insoles, interferential therapy, laser/light therapy, manual therapy, neuromuscular electrical stimulation, pulsed electrical stimulation, pulsed electromagnetic fields, static magnets and transcutaneous electrical nerve Stimulation (TENS), based on all relevant data, to facilitate a more complete assessment of value. METHODS Data from 88 randomised controlled trials including 7,507 patients were obtained from a systematic review. The studies reported a wide range of outcomes. These were converted into EQ-5D index values using prediction models, and synthesised using network meta-analysis. Analyses were conducted including firstly all trials and secondly only trials with low risk of selection bias. Resource use was estimated from trials, expert opinion and the literature. A decision analytic model synthesised all evidence to assess interventions over a typical treatment period (constant benefit over eight weeks or linear increase in effect over weeks zero to eight and dissipation over weeks eight to 16). RESULTS When all trials are considered, TENS is cost-effective at thresholds of £20-30,000 per QALY with an incremental cost-effectiveness ratio of £2,690 per QALY vs. usual care. When trials with a low risk of selection bias are considered, acupuncture is cost-effective with an incremental cost-effectiveness ratio of £13,502 per QALY vs. TENS. The results of the analysis were sensitive to varying the intensity, with which interventions were delivered, and the magnitude and duration of intervention effects on EQ-5D. CONCLUSIONS Using the £20,000 per QALY NICE threshold results in TENS being cost-effective if all trials are considered. If only higher quality trials are considered, acupuncture is cost-effective at this threshold, and thresholds down to £14,000 per QALY.
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Affiliation(s)
- Beth Woods
- Centre for Health Economics, University of York, York, United Kingdom
| | - Andrea Manca
- Centre for Health Economics, University of York, York, United Kingdom
| | - Helen Weatherly
- Centre for Health Economics, University of York, York, United Kingdom
| | - Pedro Saramago
- Centre for Health Economics, University of York, York, United Kingdom
| | | | | | - Stephen Rice
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
| | - Mark Corbett
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
| | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Matthew Bowes
- York Teaching Hospital NHS Foundation Trust, York, United Kingdom
| | - Hugh MacPherson
- Department of Health Sciences, University of York, York, United Kingdom
| | - Mark Sculpher
- Centre for Health Economics, University of York, York, United Kingdom
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Mendonça Araújo F, Alves Menezes M, Martins de Araújo A, Abner Dos Santos Sousa T, Vasconcelos Lima L, Ádan Nunes Carvalho E, Melo DeSantana J. Validation of a New Placebo Interferential Current Method: A New Placebo Method of Electrostimulation. PAIN MEDICINE 2017; 18:86-94. [PMID: 27048345 DOI: 10.1093/pm/pnw039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective The present study aimed to investigate if a new placebo device for interferential current (IFC) that delivers current during only the first 40 seconds of stimulation is effective at promoting adequate subject blinding. Methods Seventy-five subjects were recruited and enrolled into three groups: active IFC, inactive placebo, and new placebo. Pressure pain threshold (PPT), cutaneous sensory threshold (CST), and pain intensity were measured before and after the intervention. After the final assessment, the subjects and the investigator who applied the current were asked about the type of stimulation administered. Results None of the placebo forms studied resulted in significant changes to PPT, CST, or pain intensity. The subjects stimulated with active IFC at high intensities (> 17 mA) of stimulation showed higher PPT and CST and lower pain intensity than subjects stimulated at low intensities ( p < 0.03). The new placebo method blinded the investigator in 100% of cases of IFC and 60% of subjects stimulated, whereas for inactive placebo, the investigator was blinded at a rate of 0% and 34% of subjects. Conclusion The new method of placebo IFC was effective for blinding of research investigators and most of the active IFC-treated subjects, promoting an appropriate placebo method.
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Affiliation(s)
- Fernanda Mendonça Araújo
- Departamento de Fisioterapia, Universidade Federal de Sergipe, Aracaju, Se, Brazil.,Programa de Pós-Graduação em Ciências Fisiológicas, Universidade Federal de Sergipe, Aracaju, Se, Brazil
| | - Mayara Alves Menezes
- Departamento de Fisioterapia, Universidade Federal de Sergipe, Aracaju, Se, Brazil
| | | | - Thiago Abner Dos Santos Sousa
- Departamento de Fisioterapia, Universidade Federal de Sergipe, Aracaju, Se, Brazil.,Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, Se, Brazil
| | - Lucas Vasconcelos Lima
- Departamento de Fisioterapia, Universidade Federal de Sergipe, Aracaju, Se, Brazil.,Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, Se, Brazil
| | - Elyson Ádan Nunes Carvalho
- Departamento de Engenharia Elétrica, Programa de Pós-Graduação em Engenharia Elétrica, Universidade Federal de Sergipe, Aracaju, Se, Brazil
| | - Josimari Melo DeSantana
- Departamento de Fisioterapia, Universidade Federal de Sergipe, Aracaju, Se, Brazil.,Programa de Pós-Graduação em Ciências Fisiológicas, Universidade Federal de Sergipe, Aracaju, Se, Brazil.,Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, Se, Brazil
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MacPherson H, Vickers A, Bland M, Torgerson D, Corbett M, Spackman E, Saramago P, Woods B, Weatherly H, Sculpher M, Manca A, Richmond S, Hopton A, Eldred J, Watt I. Acupuncture for chronic pain and depression in primary care: a programme of research. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05030] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BackgroundThere has been an increase in the utilisation of acupuncture in recent years, yet the evidence base is insufficiently well established to be certain about its clinical effectiveness and cost-effectiveness. Addressing the questions related to the evidence base will reduce uncertainty and help policy- and decision-makers with regard to whether or not wider access is appropriate and provides value for money.AimOur aim was to establish the most reliable evidence on the clinical effectiveness and cost-effectiveness of acupuncture for chronic pain by drawing on relevant evidence, including recent high-quality trials, and to develop fresh evidence on acupuncture for depression. To extend the evidence base we synthesised the results of published trials using robust systematic review methodology and conducted a randomised controlled trial (RCT) of acupuncture for depression.Methods and resultsWe synthesised the evidence from high-quality trials of acupuncture for chronic pain, consisting of musculoskeletal pain related to the neck and low back, osteoarthritis of the knee, and headache and migraine, involving nearly 18,000 patients. In an individual patient data (IPD) pairwise meta-analysis, acupuncture was significantly better than both sham acupuncture (p < 0.001) and usual care (p < 0.001) for all conditions. Using network meta-analyses, we compared acupuncture with other physical therapies for osteoarthritis of the knee. In both an analysis of all available evidence and an analysis of a subset of better-quality trials, using aggregate-level data, we found acupuncture to be one of the more effective therapies. We developed new Bayesian methods for analysing multiple individual patient-level data sets to evaluate heterogeneous continuous outcomes. An accompanying cost-effectiveness analysis found transcutaneous electrical nerve stimulation (TENS) to be cost-effective for osteoarthritis at a threshold of £20,000 per quality-adjusted life-year when all trials were synthesised. When the analysis was restricted to trials of higher quality with adequate allocation concealment, acupuncture was cost-effective. In a RCT of acupuncture or counselling compared with usual care for depression, in which half the patients were also experiencing comorbid pain, we found acupuncture and counselling to be clinically effective and acupuncture to be cost-effective. For patients in whom acupuncture is inappropriate or unavailable, counselling is cost-effective.ConclusionWe have provided the most robust evidence from high-quality trials on acupuncture for chronic pain. The synthesis of high-quality IPD found that acupuncture was more effective than both usual care and sham acupuncture. Acupuncture is one of the more clinically effective physical therapies for osteoarthritis and is also cost-effective if only high-quality trials are analysed. When all trials are analysed, TENS is cost-effective. Promising clinical and economic evidence on acupuncture for depression needs to be extended to other contexts and settings. For the conditions we have investigated, the drawing together of evidence on acupuncture from this programme of research has substantially reduced levels of uncertainty. We have identified directions for further research. Our research also provides a valuable basis for considering the potential role of acupuncture as a referral option in health care and enabling providers and policy-makers to make decisions based on robust sources of evidence.Trial registrationCurrent Controlled Trials ISRCTN63787732.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
| | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin Bland
- Department of Health Sciences, University of York, York, UK
| | | | - Mark Corbett
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Eldon Spackman
- Centre for Health Economics, University of York, York, UK
| | - Pedro Saramago
- Centre for Health Economics, University of York, York, UK
| | - Beth Woods
- Centre for Health Economics, University of York, York, UK
| | | | - Mark Sculpher
- Centre for Health Economics, University of York, York, UK
| | - Andrea Manca
- Centre for Health Economics, University of York, York, UK
| | | | - Ann Hopton
- Department of Health Sciences, University of York, York, UK
| | - Janet Eldred
- Department of Health Sciences, University of York, York, UK
| | - Ian Watt
- Department of Health Sciences/Hull York Medical School, University of York, York, UK
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Eftekharsadat B, Babaei-Ghazani A, Habibzadeh A, Kolahi B. Efficacy of action potential simulation and interferential therapy in the rehabilitation of patients with knee osteoarthritis. Ther Adv Musculoskelet Dis 2015; 7:67-75. [PMID: 26029268 DOI: 10.1177/1759720x15575724] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Knee osteoarthritis (OA) is the main cause of pain, physical impairment and chronic disability in older people. Electrotherapeutic modalities such as interferential therapy (IFT) and action potential simulation (APS) are used for the treatment of knee OA. In this study, we aim to evaluate the therapeutic effects of APS and IFT on knee OA. METHODS In this randomized clinical trial, 67 patients (94% female and 6% male with mean age of 52.80 ± 8.16 years) with mild and moderate knee OA were randomly assigned to be treated with APS (n = 34) or IFT (n = 33) for 10 sessions in 4 weeks. Baseline and post-treatment Western Ontario and McMaster Universities Osteoarthritis (WOMAC) subscales, visual analogue scale (VAS) and timed up and go (TUG) test were measured in all patients. RESULTS VAS and WOMAC subscales were significantly improved after treatment in APS and IFT groups (p < 0.001 for all). TUG was also significantly improved after treatment in APS group (p < 0.001), but TUG changes in IFT was not significant (p = 0.09). There was no significant difference in VAS, TUG and WOMAC subscales values before and after treatment as well as the mean improvement in VAS, TUG and WOMAC subscales during study between groups. CONCLUSION Short-term treatment with both APS and IFT could significantly reduce pain and improve physical function in patients with knee OA.
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Affiliation(s)
- Bina Eftekharsadat
- Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arash Babaei-Ghazani
- Department of Physical Medicine and Rehabilitation, Iran University of Medical Sciences, Firozgar Hospital, Valiasr square, Tehran 1593748711, Iran
| | - Afshin Habibzadeh
- Medical Education Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Babak Kolahi
- Physical Medicine and Rehabilitation Specialist, Tabriz University of Medical Sciences, Tabriz, Iran
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Zeng C, Li H, Yang T, Deng ZH, Yang Y, Zhang Y, Lei GH. Electrical stimulation for pain relief in knee osteoarthritis: systematic review and network meta-analysis. Osteoarthritis Cartilage 2015; 23:189-202. [PMID: 25497083 DOI: 10.1016/j.joca.2014.11.014] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 10/15/2014] [Accepted: 11/14/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the efficacy of different electrical stimulation (ES) therapies in pain relief of patients with knee osteoarthritis (OA). METHOD Electronic databases including MEDLINE, Embase and Cochrane Library were searched through for randomized controlled trials (RCTs) comparing any ES therapies with control interventions (sham or blank) or with each other. Bayesian network meta-analysis was used to combine both the direct and indirect evidence on treatment effectiveness. RESULTS 27 trials and six kinds of ES therapies, including high-frequency transcutaneous electrical nerve stimulation (h-TENS), low-frequency transcutaneous electrical nerve stimulation (l-TENS), neuromuscular electrical stimulation (NMES), interferential current (IFC), pulsed electrical stimulation (PES), and noninvasive interactive neurostimulation (NIN), were included. IFC is the only significantly effective treatment in terms of both pain intensity and change pain score at last follow-up time point when compared with the control group. Meanwhile, IFC showed the greatest probability of being the best option among the six treatment methods in pain relief. These estimates barely changed in sensitivity analysis. However, the evidence of heterogeneity and the limitation in sample size of some studies could be a potential threat to the validity of results. CONCLUSION IFC seems to be the most promising pain relief treatment for the management of knee OA. However, evidence was limited due to the heterogeneity and small number of included trials. Although the recommendation level of the other ES therapies is either uncertain (h-TENS) or not appropriate (l-TENS, NMES, PES and NIN) for pain relief, it is likely that none of the interventions is dangerous. LEVEL OF EVIDENCE LevelⅡ, systematic review and network meta-analysis of RCTs.
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Affiliation(s)
- C Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - H Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - T Yang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Z-h Deng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Y Yang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Y Zhang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - G-h Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan Province, China.
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Abstract
Osteoarthritis (OA) is prevalent in today's population, including the athletic and recreationally active "middle-aged" population. OA is a degenerative condition of the articular/hyaline cartilage of synovial joints and commonly affects the knee joint. In general, athletic participation does not specifically influence a higher incidence of knee OA in this population; however, traumatic injury to the knee joint poses a definitive risk in developing early-onset OA. The purpose of this article is to review evidence-based nonpharmacological interventions for the conservative management of knee OA. Manual therapy, therapeutic exercise, patient education, and weight management are strongly supported in the literature for conservative treatment of knee OA. Modalities [thermal, electrical stimulation (ES), and low-level laser therapy (LLLT)] and orthotic intervention are moderately supported in the literature as indicated management strategies for knee OA. While many strongly supported conservative interventions have been published, additional research is needed to determine the most effective approach in treating knee OA.
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