The Efficacy of the Addition of TDCS and TENS to an Education and Exercise Program in Subjects with Knee Osteoarthritis: A Randomized Controlled Trial

Overview

Journal Biomedicines

Specialty Biomedical Engineering

Date 2024 Jun 27

PMID 38927392

Authors

Joaquina Montilla-Herrador

Jose Lozano-Meca

Juan Vicente Lozano-Guadalajara

Mariano Gacto-Sanchez

Affiliations

Soon will be listed here.

Abstract

Knee osteoarthritis (KOA) has a significant impact on patients' quality of life. This study aimed to assess the effectiveness of integrating transcranial direct current stimulation (tDCS) and transcutaneous electrical nerve stimulation (TENS) into an education and exercise program with the aim of decreasing pain and improving physical function in KOA. A randomized controlled trial with 65 KOA patients was conducted. The subjects were assigned to one of the following three groups: education and active exercise plus (1) double active tDCS and TENS, (2) active tDCS and sham TENS, and (3) double sham tDCS and TENS. Sessions were conducted over a 20 min period, whilst data on pain, chronic pain clinical variables, and physical function were collected. Although all groups showed improvement in pain-related symptoms in the short and medium term, the addition of tDCS and/or TENS did not significantly enhance the benefits of the exercise and education program. These findings suggest that an education and active exercise program in the treatment of KOA has a positive effect on pain, with or without the addition of tDCS and/or TENS.

References

Alghadir A, Anwer S, Iqbal A, Iqbal Z . Test-retest reliability, validity, and minimum detectable change of visual analog, numerical rating, and verbal rating scales for measurement of osteoarthritic knee pain. J Pain Res. 2018; 11:851-856. PMC: 5927184. DOI: 10.2147/JPR.S158847. View

Kohn M, Sassoon A, Fernando N . Classifications in Brief: Kellgren-Lawrence Classification of Osteoarthritis. Clin Orthop Relat Res. 2016; 474(8):1886-93. PMC: 4925407. DOI: 10.1007/s11999-016-4732-4. View

Holm P, Petersen K, Wernbom M, Schroder H, Arendt-Nielsen L, Skou S . Strength training in addition to neuromuscular exercise and education in individuals with knee osteoarthritis-the effects on pain and sensitization. Eur J Pain. 2021; 25(9):1898-1911. DOI: 10.1002/ejp.1796. View

Fonteneau C, Mondino M, Arns M, Baeken C, Bikson M, Brunoni A . Sham tDCS: A hidden source of variability? Reflections for further blinded, controlled trials. Brain Stimul. 2019; 12(3):668-673. DOI: 10.1016/j.brs.2018.12.977. View

Bohannon R . Considerations and Practical Options for Measuring Muscle Strength: A Narrative Review. Biomed Res Int. 2019; 2019:8194537. PMC: 6354207. DOI: 10.1155/2019/8194537. View

Marcos-Frutos D, Lopez-Alonso V, Mera-Gonzalez I, Sanchez-Molina J, Colomer-Poveda D, Marquez G . Chronic Functional Adaptations Induced by the Application of Transcranial Direct Current Stimulation Combined with Exercise Programs: A Systematic Review of Randomized Controlled Trials. J Clin Med. 2023; 12(21). PMC: 10649950. DOI: 10.3390/jcm12216724. View

Murphy M, Latella C, Rio E, Taylor J, Martino S, Sylvester C . Does lower-limb osteoarthritis alter motor cortex descending drive and voluntary activation? A systematic review and meta-analysis. EFORT Open Rev. 2023; 8(12):883-894. PMC: 10714386. DOI: 10.1530/EOR-23-0092. View

Teixeira P, Tavares D, Pacheco-Barrios K, Branco L, Slawka E, Keysor J . Development of a Clinical Prediction Rule for Treatment Success with Transcranial Direct Current Stimulation for Knee Osteoarthritis Pain: A Secondary Analysis of a Double-Blind Randomized Controlled Trial. Biomedicines. 2023; 11(1). PMC: 9855334. DOI: 10.3390/biomedicines11010004. View

Ramos-Goni J, Craig B, Oppe M, Ramallo-Farina Y, Pinto-Prades J, Luo N . Handling Data Quality Issues to Estimate the Spanish EQ-5D-5L Value Set Using a Hybrid Interval Regression Approach. Value Health. 2018; 21(5):596-604. DOI: 10.1016/j.jval.2017.10.023. View

10.

Axford J, Butt A, Heron C, Hammond J, Morgan J, Alavi A . Prevalence of anxiety and depression in osteoarthritis: use of the Hospital Anxiety and Depression Scale as a screening tool. Clin Rheumatol. 2010; 29(11):1277-83. DOI: 10.1007/s10067-010-1547-7. View

11.

McAlindon T, Bannuru R, Sullivan M, Arden N, Berenbaum F, Bierma-Zeinstra S . OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage. 2014; 22(3):363-88. DOI: 10.1016/j.joca.2014.01.003. View

12.

Chang W, Bennell K, Hodges P, Hinman R, Young C, Buscemi V . Addition of transcranial direct current stimulation to quadriceps strengthening exercise in knee osteoarthritis: A pilot randomised controlled trial. PLoS One. 2017; 12(6):e0180328. PMC: 5493377. DOI: 10.1371/journal.pone.0180328. View

13.

Freire Perez A . [Screening methods for mild cognitive impairment in primary care]. Rev Esp Geriatr Gerontol. 2018; 52 Suppl 1:15-19. DOI: 10.1016/S0211-139X(18)30074-X. View

14.

Luque-Suarez A, Martinez-Calderon J, Falla D . Role of kinesiophobia on pain, disability and quality of life in people suffering from chronic musculoskeletal pain: a systematic review. Br J Sports Med. 2018; 53(9):554-559. DOI: 10.1136/bjsports-2017-098673. View

15.

Naugle K, Ohlman T, Naugle K, Riley Z, Keith N . Physical activity behavior predicts endogenous pain modulation in older adults. Pain. 2017; 158(3):383-390. DOI: 10.1097/j.pain.0000000000000769. View

16.

de Boer M, Waterlander W, Kuijper L, Steenhuis I, Twisk J . Testing for baseline differences in randomized controlled trials: an unhealthy research behavior that is hard to eradicate. Int J Behav Nutr Phys Act. 2015; 12:4. PMC: 4310023. DOI: 10.1186/s12966-015-0162-z. View

17.

Folstein M, Folstein S, McHugh P . "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3):189-98. DOI: 10.1016/0022-3956(75)90026-6. View

18.

Cuesta-Vargas A, Roldan-Jimenez C, Neblett R, Gatchel R . Cross-cultural adaptation and validity of the Spanish central sensitization inventory. Springerplus. 2016; 5(1):1837. PMC: 5074937. DOI: 10.1186/s40064-016-3515-4. View

19.

Pietrosimone B, Luc-Harkey B, Harkey M, Davis-Wilson H, Pfeiffer S, Schwartz T . Using TENS to Enhance Therapeutic Exercise in Individuals with Knee Osteoarthritis. Med Sci Sports Exerc. 2020; 52(10):2086-2095. DOI: 10.1249/MSS.0000000000002353. View

20.

Ahn H, Woods A, Kunik M, Bhattacharjee A, Chen Z, Choi E . Efficacy of transcranial direct current stimulation over primary motor cortex (anode) and contralateral supraorbital area (cathode) on clinical pain severity and mobility performance in persons with knee osteoarthritis: An experimenter- and.... Brain Stimul. 2017; 10(5):902-909. PMC: 5568498. DOI: 10.1016/j.brs.2017.05.007. View