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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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