Original article
Comparison of the Efficacy of Transcutaneous Electrical Nerve Stimulation, Interferential Currents, and Shortwave Diathermy in Knee Osteoarthritis: A Double-Blind, Randomized, Controlled, Multicenter Study

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Abstract

Atamaz FC, Durmaz B, Baydar M, Demircioglu OY, Iyiyapici A, Kuran B, Oncel S, Sendur OF. Comparison of the efficacy of transcutaneous electrical nerve stimulation, interferential currents, and shortwave diathermy in knee osteoarthritis: a double-blind, randomized, controlled, multicenter study.

Objective

To compare the effectiveness of transcutaneous electrical nerve stimulation (TENS), interferential currents (IFCs), and shortwave diathermy (SWD) against each other and sham intervention with exercise training and education as a multimodal package.

Design

A double-blind, randomized, controlled, multicenter trial.

Setting

Departments of physical medicine and rehabilitation in 4 centers.

Participants

Patients (N=203) with knee osteoarthritis (OA).

Interventions

The patients were randomized by the principal center into the following 6 treatment groups: TENS sham, TENS, IFCs sham, IFCs, SWD sham, and SWD. All interventions were applied 5 times a week for 3 weeks. In addition, exercises and an education program were given. The exercises were carried out as part of a home-based training program after 3 weeks' supervised group exercise.

Main Outcome Measures

Primary outcome was a visual analog scale (0–100mm) to assess knee pain. Other outcome measures were time to walk a distance of 15m, range of motion, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Nottingham Health Profile, and paracetamol intake (in grams).

Results

We found a significant decrease in all assessment parameters (P<.05), without a significant difference among the groups except WOMAC stiffness score and range of motion. However, the intake of paracetamol was significantly lower in each treatment group when compared with the sham groups at 3 months (P<.05). Also, the patients in the IFCs group used a lower amount of paracetamol at 6 months (P<.05) in comparison with the IFCs sham group.

Conclusions

Although all groups showed significant improvements, we can suggest that the use of physical therapy agents in knee OA provided additional benefits in improving pain because paracetamol intake was significantly higher in the patients who were treated with 3 sham interventions in addition to exercise and education.

Section snippets

Participants and Study Design

This was a double-blind, multicenter, randomized controlled study. Eligible outpatients were aged between 50 and 80 years with knee OA according to American College of Rheumatology criteria, radiologically confirmed with a Kellgren-Lawrence grade of 2 or 3,28 and symptomatic with at least 40mm or 4cm severity of pain on the visual analog scale (VAS) for at least 6 months. Patients were excluded if they had any experience with electrotherapy, had history of any contraindication for

Results

Figure 1 summarizes the patient recruitment, participation, and attrition during the study. No complications occurred as a result of the treatments given. None of the patients who completed the study reported any complaints leading to noncompliance for the home-based exercise program at each visit. None of the patients received other therapy, except the intake of paracetamol, during follow-up. There were no significant differences among the groups at baseline (table 1).

Discussion

This randomized, controlled, multicenter study comparing the effectiveness of TENS, IFCs, and SWD against each other and the sham groups in addition to exercise training and education in knee OA showed that all assessment parameters significantly improved in all groups without a significant difference. However, because paracetamol intake was significantly higher in patients treated with the 3 sham interventions in addition to exercise and education, it can be suggested that the use of physical

Conclusions

Although all groups showed significant improvements, paracetamol intake was significantly lower in the patients who were treated with physical therapy agents. This result supports the hypothesis that a combination treatment of a physical therapy agent, exercise, and an education program as a multidisciplinary intervention has the best outcome in patients with knee OA. On the other hand, we could not find that different physical therapy agents, including TENS, IFCs, and SWD, influenced the

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  • Cited by (0)

    Supported by Ege, Dokuz Eylul, and Adnan Menderes Universities, and Sisli Etfal Education and Research Hospital.

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

    In-press corrected proof published online on Mar 30, 2012, at www.archives-pmr.org.

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