New Guidelines for Electrical Stimulation Parameters in Adult Patients With Knee Osteoarthritis Based on a Systematic Review of the Current Literature

Abstract

Objective The goal of this systematic review was to provide guidelines for treatment parameters regarding electrical stimulation by investigating its efficacy in improving muscle strength and decreasing pain in patients with knee osteoarthritis. Design Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standard, three electronic databases (CINAHL, PubMed, and PEDro) and gray literature were used. Randomized control trials comparing electrical stimulation and conservative physical therapy were critically appraised using the 2005 University of Oxford standard. Results Nine randomized control trials were included in our review. First, our review confirmed that neuromuscular electrical stimulation is the most effective electrical stimulation treatment in the management of knee OA, and its efficiency is higher when combined with a strengthening program. Second, frequency of at least 50 Hz and no more than 75 Hz with a pulse duration between 200 and 400 μs and a treatment duration of 20 mins is necessary for successful treatment. Conclusions For the first time, our review provides standardized clinical treatment parameters for neuromuscular electrical stimulation to be included in a strengthening program for the adult patient with knee OA. To Claim CME Credits Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives Upon completion of this article, the reader should be able to: (1) Recall the impact of quadriceps femoris weakness on joint stability; (2) Summarize the mechanism of action of neuromuscular electrical stimulation (NMES) on reducing pain and increasing muscle strength; and (3) Plan the clinical treatment parameters of NMES to be included in a strengthening program for an adult patient with knee osteoarthritis. Level Advanced. Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Systematic Review Shows Tele-Rehabilitation Might Achieve Comparable Results to Office-Based Rehabilitation for Decreasing Pain in Patients with Knee Osteoarthritis

“…Several rehabilitation methods have been proven effective at decreasing pain and OA progression, such as neuro-muscular electrical stimulation [ 10 ] and exercise programs [ 11 , 12 , 13 , 14 ]. For instance, strengthening the muscles around the knee relieves some of the stress on the joint itself, allowing for the slowing down of the degeneration of the articular cartilage and the vicious circle of degradation.…”

Lab-based feasibility and acceptability of neuromuscular electrical stimulation in hip osteoarthritis rehabilitation

“…These findings are promising given the success of NMES applied to the knee extensors in individuals with knee osteoarthritis, whereby electrical stimulation has been shown to increase strength, train endurance, minimise atrophy, reduce pain and increase range of motion. 23,57 Future research is required to examine the effectiveness of NMES for improving knee extensor strength and endurance in the hip osteoarthritis population.…”

Osteoarthritis of the Knee in Middle-age Athletes: Many Measures are Practiced, but Lack Sound Scientific Evidence

“…82 NMES is the most effective type of ES on pain in patients with OA of the knee. 83,84 In particular, the protocols with significant decrease of pain used frequency between 50 and 75 Hz, pulse duration between 200 and 400 μs, and sessions of at least 20 minutes. Higher frequencies do not provide additional effects.…”