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Reichenbach S, Jüni P, Hincapié CA, Schneider C, Meli DN, Schürch R, Streit S, Lucas C, Mebes C, Rutjes AWS, da Costa BR. Effect of transcutaneous electrical nerve stimulation (TENS) on knee pain and physical function in patients with symptomatic knee osteoarthritis: the ETRELKA randomized clinical trial. Osteoarthritis Cartilage 2022; 30:426-435. [PMID: 34826572 DOI: 10.1016/j.joca.2021.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/30/2021] [Accepted: 10/27/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the effectiveness of TENS at relieving pain and improving physical function as compared to placebo TENS, and to determine its safety, in patients with knee osteoarthritis. METHODS Multi-centre, parallel, 1:1 randomized, double-blind, placebo-controlled clinical trial conducted in six outpatient clinics in Switzerland. We included 220 participants with knee osteoarthritis recruited between October 15, 2012, and October 15, 2014. Patients were randomized to 3 weeks of treatment with TENS (n = 108) or placebo TENS (n = 112). Our pre-specified primary endpoint was knee pain at the end of 3-weeks treatment assessed with the WOMAC pain subscale. Secondary outcome measures included WOMAC physical function subscale and safety outcomes. RESULTS There was no difference between TENS and placebo TENS in WOMAC pain at the end of treatment (mean difference -0.06; 95%CI -0.41 to 0.29; P = 0.74), nor throughout the trial duration (P = 0.98). Subgroup analyses did not indicate an interaction between patient/treatment characteristics and treatment effect on WOMAC pain at the end of treatment (P-interaction ≥0.22). The occurrence of adverse events was similar across groups, with 10.4% and 10.6% of patients reporting events in the TENS and placebo TENS groups, respectively (P = 0.95). No relevant differences were observed in secondary outcomes. CONCLUSIONS TENS does not improve knee osteoarthritis pain when compared to placebo TENS. Therapists should consider other potentially more effective treatment modalities to decrease knee osteoarthritis pain and facilitate strengthening and aerobic exercise. Our findings are conclusive and further trials comparing TENS and placebo TENS in this patient population are not necessary.
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Affiliation(s)
- S Reichenbach
- Institute for Social and Preventive Medicine (ISPM), University of Bern, Switzerland; Department of Rheumatology and Immunology, Bern University Hospital, Switzerland
| | - Peter Jüni
- Institute of Health Policy, Management, and Evaluation, Department of Medicine, University of Toronto, Toronto, Canada; Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada
| | - C A Hincapié
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada; Department of Chiropractic Medicine, Faculty of Medicine, University of Zurich and Balgrist University Hospital, Zurich, Switzerland; Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - C Schneider
- Institute for Social and Preventive Medicine (ISPM), University of Bern, Switzerland; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - D N Meli
- General Practice, Huttwil, Switzerland
| | - R Schürch
- Institute for Social and Preventive Medicine (ISPM), University of Bern, Switzerland; CTU Bern, University of Bern, Switzerland; Department of Entomology, Virginia Tech Polytechnic Institute & State University, Blacksburg, USA
| | - S Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - C Lucas
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, University of Amsterdam, Faculty of Medicine (AMC), Amsterdam, the Netherlands
| | - C Mebes
- Physio Postmarkt AG, Grenchen, Switzerland
| | - A W S Rutjes
- Institute for Social and Preventive Medicine (ISPM), University of Bern, Switzerland
| | - B R da Costa
- Institute of Health Policy, Management, and Evaluation, Department of Medicine, University of Toronto, Toronto, Canada; Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada; Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
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von Wolff M, Kohl Schwartz A, Stute P, Fäh M, Otti G, Schürch R, Rohner S. Follicular flushing in natural cycle IVF does not affect the luteal phase - a prospective controlled study. Reprod Biomed Online 2017; 35:37-41. [PMID: 28483339 DOI: 10.1016/j.rbmo.2017.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 04/03/2017] [Accepted: 04/04/2017] [Indexed: 11/24/2022]
Abstract
In contrast to multifollicular IVF, follicular flushing seems to increase the efficacy of monofollicular IVF treatments such as natural cycle IVF (NC-IVF). However, because follicular flushing causes loss of granulosa cells, it might negatively affect luteal phase length and endocrine function of the luteal body. A prospective cohort Phase II study was performed in 24 women undergoing NC-IVF. Women underwent a reference cycle with human chorionic gonadotrophin-induced ovulation without follicle aspiration and analysis of the length of the luteal phase and luteal concentrations of progesterone and oestradiol. In addition, they underwent a NC-IVF cycle which was performed identically but follicles were aspirated and flushed three times. The luteal phase was shorter in 29.2%, equal in 16.7% and longer in 50.0% of cases following flushing of the follicles. Overall, neither difference in luteal phase length was significant [median duration (interquartile range) in reference cycle: 13 (12; 14.5), IVF (flushing) cycle: 14 (12.5; 14.5), median difference (95% CI): 0.5 (-0.5 to 1.5)] nor median progesterone and oestradiol concentrations. In conclusion, follicular flushing in NC-IVF affects neither the length of the luteal phase nor the luteal phase concentrations of progesterone and oestradiol, questioning the need for luteal phase supplementation.
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Affiliation(s)
- M von Wolff
- University Women's Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, Berne, Switzerland.
| | - A Kohl Schwartz
- University Women's Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, Berne, Switzerland
| | - P Stute
- University Women's Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, Berne, Switzerland
| | - M Fäh
- University Women's Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, Berne, Switzerland
| | - G Otti
- University Women's Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, Berne, Switzerland
| | - R Schürch
- CTU Berne, Department of Clinical Research, Institute of Social and Preventive Medicine (ISPM), University of Berne, Berne, Switzerland
| | - S Rohner
- University Women's Hospital, Division of Gynaecological Endocrinology and Reproductive Medicine, Berne, Switzerland
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Rohner S, Fäh M, Otti G, Kohl Schwartz A, Stute P, Schürch R, Wolff MV. Follikelspülungen bei Natural Cycle-IVF-Behandlungen verkürzen weder die Lutealphasenlänge noch die luteale Hormonsekretion – eine prospektiv kontrollierte Studie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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