title: Transcutaneous electrical nerve stimulation as an adjunct to education and exercise for knee osteoarthritis: a randomized controlled trial.
abstract: OBJECTIVE
  To determine the additional effects of transcutaneous electrical nerve stimulation (TENS) for knee osteoarthritis (OA) when combined with a group education and exercise program (knee group).
  
  
  METHODS
  The study was a randomized, sham-controlled clinical trial. Patients referred for physiotherapy with suspected knee OA (confirmed using the American College of Rheumatology clinical criteria) were invited. Exclusion criteria included comorbidities preventing exercise, previous TENS experience, and TENS contraindications. Prospective sample size calculations required 67 participants in each trial arm. A total of 224 participants (mean age 61 years, 37% men) were randomized to 3 arms: TENS and knee group (n = 73), sham TENS and knee group (n = 74), and knee group (n = 77). All patients entered an evidence-based 6-week group education and exercise program (knee group). Active TENS produced a "strong but comfortable" paraesthesia within the painful area and was used as much as needed during the 6-week period. Sham TENS used dummy devices with no electrical output. Blinded assessment took place at baseline and 3, 6, 12, and 24 weeks. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function subscale at 6 weeks. Secondary outcomes included WOMAC pain, stiffness, and total scores; extensor muscle torque; global assessment of change; exercise adherence; and exercise self-efficacy. Data analysis was by intent to treat.
  
  
  RESULTS
  All outcomes improved over time (P < 0.05), but there were no differences between trial arms (P > 0.05). All improvements were maintained at 24-week followup.
  
  
  CONCLUSIONS
  There were no additional benefits of TENS, failing to support its use as a treatment adjunct within this context.
authors: University of the West of England, Bristol, UK.
authors: Shea
authors: S
authors: Palmer
authors: Melissa
authors: M
authors: Domaille
authors: Fiona
authors: F
authors: Cramp
authors: Nicola
authors: N
authors: Walsh
authors: Jon
authors: J
authors: Pollock
authors: John
authors: J
authors: Kirwan
authors: Mark I
authors: MI
authors: Johnson
mesh_terms: D000368:Aged; D015444:Exercise; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000628:therapy*; D010349:Patient Compliance; D010353:Patient Education as Topic; D018579:Patient Selection; D004561:Transcutaneous Electric Nerve Stimulation; D016896:Treatment Outcome