title: Comparison of intra-articular hyaluronic acid injections with transcutaneous electric nerve stimulation for the management of knee osteoarthritis: a randomized controlled trial.
abstract: OBJECTIVE
  To compare the effects of intra-articular hyaluronic acid (HA; ARTZ) and transcutaneous electric nerve stimulation (TENS) in the treatment of patients with knee osteoarthritis.
  
  
  METHODS
  A prospective, randomized controlled trial.
  
  
  METHODS
  Rehabilitation clinic of a teaching hospital.
  
  
  METHODS
  Patients with knee osteoarthritis (N=50; aged 51-80y) were randomly assigned to the HA group (n=27) or the TENS group (n=23).
  
  
  METHODS
  The HA group received intra-articular HA injection into the affected knee once a week for 5 consecutive weeks, and the TENS group received a 20- minute session of TENS 3 times a week for 4 consecutive weeks.
  
  
  METHODS
  The primary outcome measures used were the visual analog scale (VAS) for pain and the Lequesne index. The secondary outcome measures were range of motion of the knee, walking time, pain threshold, patient global assessment, and disability in activities of daily living. All subjects were assessed at baseline, and at 2 weeks, 2 months, and 3 months after the treatments were completed.
  
  
  RESULTS
  The TENS group exhibited a significantly greater improvement in VAS than the HA group at 2 weeks' follow-up (4.17 ± 1.98 vs 5.31 ± 1.78, respectively; P=.03). In addition, the TENS group also exhibited a significantly greater improvement in the Lequesne index than the HA group at 2 weeks' follow-up (7.78 ± 2.08 vs 9.85 ± 3.54, respectively; P=.01) and at 3 months' follow-up (7.07 ± 2.85 vs 9.24 ± 4.04, respectively; P=.03).
  
  
  CONCLUSIONS
  TENS with silver spike point electrodes was observed to be more effective than intra-articular HA injection for patients with knee osteoarthritis in improving the VAS for pain at 2 weeks' follow-up as well as the Lequesne index at 2 weeks' and 3 months' follow-up.
authors.affiliation: Department of Physical Medicine & Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, ROC.
authors.forename: Wen-Ling
authors.initials: WL
authors.lastname: Chen
authors.forename: Wei-Chun
authors.initials: WC
authors.lastname: Hsu
authors.forename: Yi-Jia
authors.initials: YJ
authors.lastname: Lin
authors.forename: Lin-Fen
authors.initials: LF
authors.lastname: Hsieh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000503:physiopathology / Q000628:therapy*; D016059:Range of Motion, Articular / Q000502:physiology; D004561:Transcutaneous Electric Nerve Stimulation; D016896:Treatment Outcome; D055675:Viscosupplements / Q000627:therapeutic use*; D016138:Walking / Q000502:physiology
chemical_list: D055675:Viscosupplements; D006820:Hyaluronic Acid
keywords: ACR; ADL; American College of Rheumatology; HA; Hyaluronic acid; Injections, intra-articular; MCII; OA; Osteoarthritis, knee; ROM; Rehabilitation; SSP; TENS; Transcutaneous electric nerve stimulation; VAS; activities of daily living; hyaluronic acid; minimal clinically important improvement; osteoarthritis; range of motion; silver spike point; transcutaneous electric nerve stimulation; visual analog scale