Effectiveness of transcutaneous electrical nerve stimulation for pain in knee osteoarthritis: A systematic review and meta-analysis
DOI:
https://doi.org/10.25170/djm.v25i2.3607Keywords:
knee osteoarthritis, meta-analysis, pain, systematic review, transcutaneous electrical nerve stimulationAbstract
Introduction: Knee osteoarthritis (OA) is a common cause of chronic pain and disability. Transcutaneous electrical nerve stimulation (TENS) is a non-pharmacological analgesic option, but its efficacy remains uncertain. This systematic review and meta-analysis evaluated the effectiveness and safety of TENS in knee OA.
Methods: PubMed, ScienceDirect, EBSCO, ProQuest, and ClinicalTrials.gov were searched from database inception to 9 March 2021 without language or publication-date restrictions. Randomized controlled trials comparing TENS with a control were eligible. Risk of bias was assessed using RoB 2, certainty of evidence using GRADE, and outcomes were pooled using random-effects models with Hartung-Knapp adjustment.
Results: Of 335 records identified, 11 randomized controlled trials met the qualitative inclusion criteria and eight contributed to the pain meta-analysis. Overall risk of bias was low in four studies, raised some concerns in four, and high in three. TENS showed a directionally lower pain score, but the pooled effect was imprecise (Hedges g -0.53, 95% CI -1.24 to 0.18; I²=76%). Function also showed an imprecise difference (MD -3.74, 95% CI -9.77 to 2.29), as did adverse events (RR 0.65, 95% CI 0.23 to 1.80).
Conclusion: Pooled estimates suggest a possible benefit of TENS for knee OA pain and function, but the evidence is imprecise and heterogeneous. More rigorous, adequately powered sham-controlled trials and an updated evidence synthesis are required.
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