What is the evidence for electro-stimulation in the treatment of osteoarthritis of the knee?
AMSTAR Rating
Summary
Patient Population:
≥70% study participants were female. Recruitment was limited primarily to older adults with knee OA. Most were overweight – reported BMI averages 29 kg/m2. Approximately ½ of participants were prescribed concomitant anti-inflammatory medication or pain relievers in addition to PT intervention.
Intervention:
This review looked at: aerobic exercise, aquatic exercise, strengthening exercise, ultrasonography, proprioception exercise, Tai Chi, education programs, diathermy, orthotics, magnetic stimulation. 7 studies (n=390) looked at electro-stimulation.
Comparison:
There were 212 articles identified (corresponding to 193 RCTs). Most RCTs demonstrated adequate randomization; however, concealment of allocation was unclear in the majority of trials identified (129/193). In addition, there was no planned ITT analysis described in 118 trials. One-third of the studies identified for inclusion did not describe masking of outcome assessment. 84 trials contributed data for pooling with regard to pain, physical function and disability. The strength of evidence was downgraded overall due to the risk for bias and low precision (wide CIs) associated with estimated treatment effects.
Outcome:
- Pain: electro-stimulation vs. placebo – significant benefit in favour of electro-stimulation at <6 weeks (SMD=-0.71; 95% CI -0.98 to -0.43).
- Pain: electro-stimulation – significant increase in pain associated with electro-stimulation at 6 months (SMD=0.57; 95% CI 0.09 to 1.06; VAS=12.5 mm).
