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

• Published in: Archives of physical medicine and rehabilitation Vol. 93; no. 5; pp. 748 - 756
• Main Authors: Atamaz, Funda C., MD, Durmaz, Berrin, MD, Baydar, Meltem, MD, Demircioglu, Ozlem Y., MD, Iyiyapici, Ayse, MD, Kuran, Banu, MD, Oncel, Sema, MD, Sendur, Omer F., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2012; Elsevier
• Subjects: Acetaminophen - therapeutic use; Aged; Analysis of Variance; Arthralgia - etiology; Biological and medical sciences; Clinical trials; Combined Modality Therapy; Diathermy; Diseases of the osteoarticular system; Double-Blind Method; Exercise Therapy; Female; Humans; Knee; Male; Medical sciences; Middle Aged; Miscellaneous; Miscellaneous. Osteoarticular involvement in other diseases; Nerves; Osteoarthritis; Osteoarthritis, knee; Osteoarthritis, Knee - complications; Osteoarthritis, Knee - physiopathology; Osteoarthritis, Knee - therapy; Pain; Pain Measurement; paracetamol; Patient Education as Topic; Physical Medicine and Rehabilitation; Physical training; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Range of Motion, Articular; Rehabilitation; Time Factors; Transcutaneous Electric Nerve Stimulation; Walking - physiology; Nottingham Health Profile; SWD; RCT; CI; osteoarthritis; transcutaneous electrical nerve stimulation; IFC; Western Ontario and McMaster Universities Osteoarthritis Index; Osteoarthritis, knee; VAS; visual analog scale; randomized controlled trial; TENS; OA; shortwave diathermy; NHP; WOMAC; confidence interval; Rehabilitation; interferential current; Transcutaneous electric nerve stimulation; Knee; Knee osteoarthritis; Diseases of the osteoarticular system; Electric; Diathermy; Reeducation; Orthopedics; Arthropathy; Double blind study; Degenerative disease; Osteoarthritis; Comparative study
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2011.11.037

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.