The effects of various physical non-operative modalities on the pain in osteoarthritis of the knee

Abstract

The purpose of this study was to evaluate the effect of various non-operative modalities of treatment (transcutaneous electrical nerve stimulation (TENS); neuromuscular electrical stimulation (NMES); insoles and bracing) on the pain of osteoarthritis (OA) of the knee. We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify the therapeutic options which are commonly adopted for the management of osteoarthritis (OA) of the knee. The outcome measurement tools used in the different studies were the visual analogue scale and The Western Ontario and McMaster Universities Arthritis Index pain index: all pain scores were converted to a 100-point scale. A total of 30 studies met our inclusion criteria: 13 on insoles, seven on TENS, six on NMES, and four on bracing. The standardised mean difference (SMD) in pain after treatment with TENS was 1.796, which represented a significant reduction in pain. The significant overall effect estimate for NMES on pain was similar to that of TENS, with a SMD of 1.924. The overall effect estimate of insoles on pain was a SMD of 0.992. The overall effect of bracing showed a significant reduction in pain of 1.34. Overall, all four non-operative modalities of treatment were found to have a significant effect on the reduction of pain in OA of the knee. This study shows that non-operative physical modalities of treatment are of benefit when treating OA of the knee. However, much of the literature reviewed evaluates studies with follow-up of less than six months: future work should aim to evaluate patients with longer follow-up.

The Effectiveness of Transcutaneous Electrical Nerve Stimulation in Knee Osteoarthritis with Neuropathic Pain Component: A Randomized Controlled Study

“…(21) investigated the efficacy of electrical stimulation forms for the management of knee OA in their double-blind, randomized, controlled, multicenter trial and they showed that both knee pain and function assessment parameters were improved with TENS therapy. Cherian JJ et al (22,23) found that TENS has a significant effect on the reduction of pain in OA of the knee in their studies (22,23). The results of this study are consistent with the results of the before mentioned studies in confirming the effectiveness of TENS in osteoarthritic knees but there was not a placebo TENS group in this study so we could not show the superiority of TENS treatment over placebo group.…”

The effect of physical therapy and rehabilitation modalities on sleep quality in patients with primary knee osteoarthritis: A single-blind, prospective, randomized-controlled study

“…[33,34] It reduces pain both during activity and rest and improves functional healing. [35] It is also helpful in reducing dosage of medications used for pain control, effectively reducing undesirable side effects. [5] In previous studies examining the effectiveness of TENS, an improvement in pain with TENS application was shown, despite the heterogeneity between the studies and their relatively short follow-up period.…”

“…[5] In previous studies examining the effectiveness of TENS, an improvement in pain with TENS application was shown, despite the heterogeneity between the studies and their relatively short follow-up period. [35][36][37] A study reported that heat and US applications did not provide enough evidence for efficacy in reducing pain, [37] whereas another study found that therapeutic US was a beneficial and safe treatment modality for reducing pain and improving function in patients with knee OA. [38] Zeng et al [39] also demonstrated that pulsed US was beneficial in reducing pain and improving function in knee OA patients, whereas continuous US was only effective in reducing pain.…”

Non-surgical and Non-pharmacological Treatment of Knee Pain

“…Hsu et al also add that long term use of laterally wedged insoles leads to a permanent change in gait, with reduced knee adduction even without wearing insoles [42]. Several studies have also demonstrated efficacy in reducing pain experienced by knee OA patients immediately and also over a longer duration of 8 weeks [43]. Therefore the use of insoles may be a useful adjunct to treating knee OA nonconservatively.…”