Date of Award

1-1-2022

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department

Physician Assistant Studies

Abstract

Objective: The objective of this selective EBM review is to determine whether or not “is TENS an effective treatment for pain caused by knee osteoarthritis?”.

Study Design: A systematic review of three randomized controlled trials (RCTs) published between 2012 and 2019.

Data Sources: All RCTs were discovered utilizing PubMed. The articles were published in English in peer-reviewed journals and selected based on applicability and pertinence to the clinical question as well as the incorporation of patient-oriented outcomes.

Outcome Measured: Knee pain was the outcome measured using the Visual Analog Scale (VAS), which requires participants to draw a mark between the ends of a 10 cm-long horizontal line. Scores range from 0 to 10 cm or 100 mm, with 0 indicating no pain and 10 cm or 100 mm the most severe pain. Distance is measured starting from 0 and recorded to the second decimal place. Cherian et al.’s study uses points instead of cm or mm to measure VAS.

Results: In Shimoura et al.’s RCT, the use of TENS led to a reduction in VAS compared to the control group (P = 0.019), demonstrated by mean change from baseline of 0.38 cm. In the RCT by Vance et al., the use of TENS led to a reduction in VAS compared to the control group (P = 0.001), indicated by mean change from baseline of 14.76 mm. Finally, in Cherian et al.’s study, there was a reduction in VAS compared to the control group (P = 0.0416), indicated by mean change from baseline of -0.8823 points.

Conclusion: This systematic review found the evidence regarding the efficacy of TENS for knee OA pain to be conflicting, leaving the answer to this review’s objective undetermined. While Shimoura et al. and Vance et al.’s short-term studies suggested that TENS is not an effective treatment for pain due to knee OA, Cherian et al.’s longitudinal study showed a large treatment effect with considerable clinical importance. The nature of these results highlights the need for further studies that account for limitations in previous studies and provide for longer follow-ups to assess the effectiveness of TENS for knee OA pain treatment.

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