Transcutaneous Electrical Nerve Stimulation Improves Walking Performance in Patients With Intermittent Claudication

Seenan, Chris; McSwiggan, Steve; Roche, Patricia A.; Tan, Chee-Wee; Mercer, Tom; Belch, J. J. F.

doi:10.1097/jcn.0000000000000258

Cited by 10 publications

(26 citation statements)

References 38 publications

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“…Considering only the number of valid days at the group level, on average, the PAD participants experienced a WPM only twice per day and an SIWP only once a day ( Table 4). As shown in Table 4, this group of PAD participants spent 64% [52-72] of their daily time engaging in sedentary behavior and 8% [5][6][7][8][9][10][11][12][13][14][15] of their time engaging in moderate-to-vigorous physical activity. Furthermore, the number of bouts ≥10 minutes with a string of consecutive counts values ≥760 counts/min was very low, that is, 2 [1][2][3][4][5][6][7][8].…”

Section: Lower Limb Pain Manifestations and Associated Functional Lmentioning

confidence: 99%

“…3 However, the joint estimation of PFWT and MWT during walking is crucial for fully assessing the pain experienced by people with PAD particularly because different treatment options can differentially impact the pain trajectory during walking, 4 leading to independent changes in the PFWT and MWT. 5 Although the treadmill assessment of the PFWT and MWT is well standardized and has been extensively studied, 3 it remains protocol dependent, technically demanding, time-consuming, and limited to vascular laboratories. Furthermore, the maximal treadmill walking distance can exhibit substantial variation relative to the "natural" outdoor walking capacity while walking at a usual pace on a flat surface [6][7][8] and does not reflect the patient's perceived disability.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Using wearable monitors to assess daily walking limitations induced by ischemic pain in peripheral artery disease

Chaudru

Jéhannin

Müllenheim³

et al. 2019

Scandinavian Med Sci Sports

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and ENS Rennes. S. Chaudru received grants from the Bretagne region (Bourse ARED) and the SFETD/APICIL foundation. P.-Y. de Müllenheim received a PhD scholarship from the École normale supérieure de Cachan-Antenne de Bretagne (CDSN).Purpose: To develop, assess the feasibility of, and determine the clinical validity of an event-based analysis method using wearable monitors to quantify walking pain manifestations (WPMs) and stops induced by walking pain (SIWPs) during daily life walking in people with peripheral artery disease (PAD). Methods: The following two conditions were studied: a standardized outdoor walking session (OWS) and a seven-day free-living measurement (FLM) period. The PAD participants (n = 23) wore an accelerometer and a watch. They were asked to press the event marker button on the watch to indicate events related to WPMs and SIWPs. To assess the clinical validity of the method, the computed pain-free walking time (PFWT) and maximal walking time (MWT) were compared with the PFWT and MWT assessed using standard treadmill walking protocols, respectively. Results: Following OWSs, the PFWT [OWS] and MWT [OWS] were significantly correlated with the PFWT [Strandness] (r = .955, P < .001) and MWT [Strandness] (r = .821, P < .001), respectively. During the FLM, PAD participants experienced only 2 WPMs/day and 1 SIWP/day, although severely limited on the treadmill and during the OWS. The average WPMs/day were moderately correlated with the PFWT [Strandness] (r = −.54, P = .016). The PFWT [FLM] was on average 12 times longer than the PFWT [Strandness] . Interestingly, the intensity of the walking bouts as assessed by the accelerometer counts during the FLM was significantly lower than that during the OWS (45 ± 15 vs 66 ± 20 counts/s, P < .001). Conclusion: This new method offers opportunities for studies investigating the experience of living with PAD and the assessment of daily life walking capacity for both diagnostic and therapeutic purposes. K E Y W O R D S accelerometry, event history analysis, intermittent claudication, physical activity, walking 1814 | CHAUDRU et Al.

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Section: Lower Limb Pain Manifestations and Associated Functional Lmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Using wearable monitors to assess daily walking limitations induced by ischemic pain in peripheral artery disease

Chaudru

Jéhannin

Müllenheim³

et al. 2019

Scandinavian Med Sci Sports

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“…For the primary outcome measure, at 80% power and a two-tailed 5% significance level, 16 participants per group will allow detection of an effect size of 1.0 standard deviation of ACD in the Active TENS group compared to the Placebo TENS control. Attrition rates in our previous pilot studies ranged from 7.1 [17] to 10% [19]. We will recruit 20 participants in each group, allowing for 20% attrition, and therefore aim to recruit 80 participants.…”

Section: Methodsmentioning

confidence: 99%

“…Similarly, we have demonstrated in an experimental lower limb ischaemic pain model in healthy volunteers ( n = 28) that transcutaneous electrical nerve stimulation (TENS), a low-cost, CE-marked non-invasive pain management device, significantly increased pain threshold, tolerance and endurance compared to placebo TENS [18]. Our extension proof-of-concept pilot study demonstrated that TENS, when applied to patients with IC exercising on a treadmill ( n = 40), significantly improved absolute claudication distance (ACD) by 40% above placebo levels [19]. We have not assessed the ability of TENS to improve ACD when used during daily life.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Feasibility of Pain management and Patient Education for Physical Activity in Intermittent claudication (PrEPAID): protocol for a randomised controlled trial

Abaraogu

Dall

Brittenden

et al. 2019

Trials

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Background Physical activity (PA) improves functional capacity and quality of life and provides secondary prevention benefits in individuals with peripheral arterial disease (PAD) and intermittent claudication (IC). However, pain and patient lack of knowledge are key barriers to the uptake of, and adherence to, PA recommendations. This trial will test the efficacy and feasibility of a non-invasive pain management intervention with and without patient education to improve PA in individuals with PAD and IC. Methods This is a randomised, controlled assessor-blinded feasibility trial with four parallel groups. Eighty adults with PAD and IC will be randomly assigned 1:1:1:1 to Active TENS (transcutaneous electrical nerve stimulation), Placebo TENS, Active TENS + Patient education or Placebo TENS + Patient education groups. All groups will continue to receive usual care over the intervention period. Participants randomised to Active TENS will receive a TENS device (preset at 120 Hz, 200 μs) and will be instructed to use the device daily at home or elsewhere for 6 weeks with a patient-determined intensity of “strong but comfortable”. Placebo TENS group participants will receive the same model of TENS device and instructions for use as those in the active group, except that the stimulation dose will be safely altered to produce non-therapeutic, ineffective stimulation. Participants randomised to patient education will receive a one-off 3-h workshop of structured group education (four to five persons in each group) and three sets of twice-weekly phone calls. Efficacy outcomes will be assessed at baseline, after 6 weeks of intervention and at 3 months follow-up. Absolute claudication distance using the Gardner treadmill protocol will be assessed as the primary outcome. Secondary outcomes will assess initial claudication distance, daily PA and patient-reported outcomes including quality of life, pain self-efficacy, depression, disease perception and walking impairment pain intensity and quality. Feasibility outcomes will assess rates of recruitment, retention and adherence. Focus groups with participants at the end of the trial will explore the acceptability of the interventions. Discussion This trial will determine the efficacy and feasibility of using a low-cost, CE-marked non-invasive pain management modality delivered with or without a patient-centred education intervention to improve PA in individuals with PAD and IC. Trial registration ClinicalTrials.gov, NCT03204825 . Registered on 2 July 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3307-6) contains supplementary material, which is available to authorized users.

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“…Interestingly, recent evidence on the use of electrical stimulation as an intervention revealed substantial improvements in walking distance, greater than those seen in traditional supervised exercise interventions. 57 A review by Pipinos et al 58 identified the broad range of neurologic tests employed in previous research that indicate some neurologic involvement in PAD-IC. However, it is clear that this strand of investigation is under-researched in PAD-IC and requires further study to understand the…”

Section: Muscle Size Quality and Nerve Functionmentioning

confidence: 99%

A systematic review of muscle morphology and function in intermittent claudication

Harwood

King

Totty

et al. 2017

Journal of Vascular Surgery

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Previous literature has found clear evidence that strength (of the calf and thigh musculature) and calf characteristics are related to mortality and functional declines. However, this review has demonstrated the vast array of muscle groups assessed and multiple methods employed to determine strength; therefore, it is unclear exactly what measure of "strength" is impaired. Furthermore, the underlying morphologic causes of potential changes in strength are unclear. This information is essential for designing optimal exercise interventions. The data acquired during this systematic review are heterogeneous, with a substantial lack of high-quality intervention-based studies. Future research should endeavor to establish standardized testing procedures and to implement randomized controlled trials for targeted therapeutic interventions.

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Transcutaneous Electrical Nerve Stimulation Improves Walking Performance in Patients With Intermittent Claudication

Cited by 10 publications

References 38 publications

Using wearable monitors to assess daily walking limitations induced by ischemic pain in peripheral artery disease

Using wearable monitors to assess daily walking limitations induced by ischemic pain in peripheral artery disease

Efficacy and Feasibility of Pain management and Patient Education for Physical Activity in Intermittent claudication (PrEPAID): protocol for a randomised controlled trial

A systematic review of muscle morphology and function in intermittent claudication

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