Effect of Transcutaneous Electrical Nerve Stimulation on Spasticity in Adults With Stroke

A Systematic Review and Meta-analysis

Amreen Mahmood, Sundar Kumar Veluswamy, Aditi Hombali, Aditi Mullick, Manikandan N, John M. Solomon

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Objectives: (1) To determine the effect of transcutaneous electrical nerve stimulation (TENS) on poststroke spasticity. (2) To determine the effect of different parameters (intensity, frequency, duration) of TENS on spasticity reduction in adults with stroke. (3) To determine the influence of time since stroke on the effectiveness of TENS on spasticity. Data Sources: PubMed, PEDro, CINAHL, Web of Science, CENTRAL, and EMBASE databases were searched from inception to March 2017. Study Selection: Randomized controlled trial (RCT), quasi-RCT, and non-RCT were included if (1) they evaluated the effects of TENS for the management of spasticity in participants with acute or subacute or chronic stroke using clinical and neurophysiological tools; and (2) TENS was delivered either alone or as an adjunct to other treatments. Data Extraction: Two authors independently screened and extracted data from 15 of the 829 studies retrieved through the search using a pilot tested pro forma. Disagreements were resolved through discussion with other authors. Quality of studies was assessed using Cochrane risk of bias criteria. Data Synthesis: Meta-analysis was performed using a random-effects model that showed (1) TENS along with other physical therapy treatments was more effective in reducing spasticity in the lower limbs compared to placebo TENS (SMD −0.64; 95% confidence interval [95% CI], −0.98 to −0.31; P=.0001; I 2 =17%); and (2) TENS, when administered along with other physical therapy treatments, was effective in reducing spasticity when compared to other physical therapy interventions alone (SMD −0.83; 95% CI, −1.51 to −0.15; P=.02; I 2 =27%). There were limited studies to evaluate the effectiveness of TENS for upper limb spasticity. Conclusion: There is strong evidence that TENS as an adjunct is effective in reducing lower limb spasticity when applied for more than 30 minutes over nerve or muscle belly in chronic stroke survivors (review protocol registered at PROSPERO: CRD42015020151).

Original languageEnglish
Pages (from-to)751-768
Number of pages18
JournalArchives of Physical Medicine and Rehabilitation
Volume100
Issue number4
DOIs
Publication statusPublished - 01-04-2019

Fingerprint

Transcutaneous Electric Nerve Stimulation
Meta-Analysis
Stroke
Lower Extremity
Therapeutics
Randomized Controlled Trials
Confidence Intervals
Information Storage and Retrieval
PubMed
Upper Extremity
Placebos
Databases

All Science Journal Classification (ASJC) codes

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

Cite this

@article{10028ecc974d4022bc3ab17a7f74e428,
title = "Effect of Transcutaneous Electrical Nerve Stimulation on Spasticity in Adults With Stroke: A Systematic Review and Meta-analysis",
abstract = "Objectives: (1) To determine the effect of transcutaneous electrical nerve stimulation (TENS) on poststroke spasticity. (2) To determine the effect of different parameters (intensity, frequency, duration) of TENS on spasticity reduction in adults with stroke. (3) To determine the influence of time since stroke on the effectiveness of TENS on spasticity. Data Sources: PubMed, PEDro, CINAHL, Web of Science, CENTRAL, and EMBASE databases were searched from inception to March 2017. Study Selection: Randomized controlled trial (RCT), quasi-RCT, and non-RCT were included if (1) they evaluated the effects of TENS for the management of spasticity in participants with acute or subacute or chronic stroke using clinical and neurophysiological tools; and (2) TENS was delivered either alone or as an adjunct to other treatments. Data Extraction: Two authors independently screened and extracted data from 15 of the 829 studies retrieved through the search using a pilot tested pro forma. Disagreements were resolved through discussion with other authors. Quality of studies was assessed using Cochrane risk of bias criteria. Data Synthesis: Meta-analysis was performed using a random-effects model that showed (1) TENS along with other physical therapy treatments was more effective in reducing spasticity in the lower limbs compared to placebo TENS (SMD −0.64; 95{\%} confidence interval [95{\%} CI], −0.98 to −0.31; P=.0001; I 2 =17{\%}); and (2) TENS, when administered along with other physical therapy treatments, was effective in reducing spasticity when compared to other physical therapy interventions alone (SMD −0.83; 95{\%} CI, −1.51 to −0.15; P=.02; I 2 =27{\%}). There were limited studies to evaluate the effectiveness of TENS for upper limb spasticity. Conclusion: There is strong evidence that TENS as an adjunct is effective in reducing lower limb spasticity when applied for more than 30 minutes over nerve or muscle belly in chronic stroke survivors (review protocol registered at PROSPERO: CRD42015020151).",
author = "Amreen Mahmood and Veluswamy, {Sundar Kumar} and Aditi Hombali and Aditi Mullick and Manikandan N and Solomon, {John M.}",
year = "2019",
month = "4",
day = "1",
doi = "10.1016/j.apmr.2018.10.016",
language = "English",
volume = "100",
pages = "751--768",
journal = "Archives of Physical Medicine and Rehabilitation",
issn = "0003-9993",
publisher = "W.B. Saunders Ltd",
number = "4",

}

Effect of Transcutaneous Electrical Nerve Stimulation on Spasticity in Adults With Stroke : A Systematic Review and Meta-analysis. / Mahmood, Amreen; Veluswamy, Sundar Kumar; Hombali, Aditi; Mullick, Aditi; N, Manikandan; Solomon, John M.

In: Archives of Physical Medicine and Rehabilitation, Vol. 100, No. 4, 01.04.2019, p. 751-768.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Effect of Transcutaneous Electrical Nerve Stimulation on Spasticity in Adults With Stroke

T2 - A Systematic Review and Meta-analysis

AU - Mahmood, Amreen

AU - Veluswamy, Sundar Kumar

AU - Hombali, Aditi

AU - Mullick, Aditi

AU - N, Manikandan

AU - Solomon, John M.

PY - 2019/4/1

Y1 - 2019/4/1

N2 - Objectives: (1) To determine the effect of transcutaneous electrical nerve stimulation (TENS) on poststroke spasticity. (2) To determine the effect of different parameters (intensity, frequency, duration) of TENS on spasticity reduction in adults with stroke. (3) To determine the influence of time since stroke on the effectiveness of TENS on spasticity. Data Sources: PubMed, PEDro, CINAHL, Web of Science, CENTRAL, and EMBASE databases were searched from inception to March 2017. Study Selection: Randomized controlled trial (RCT), quasi-RCT, and non-RCT were included if (1) they evaluated the effects of TENS for the management of spasticity in participants with acute or subacute or chronic stroke using clinical and neurophysiological tools; and (2) TENS was delivered either alone or as an adjunct to other treatments. Data Extraction: Two authors independently screened and extracted data from 15 of the 829 studies retrieved through the search using a pilot tested pro forma. Disagreements were resolved through discussion with other authors. Quality of studies was assessed using Cochrane risk of bias criteria. Data Synthesis: Meta-analysis was performed using a random-effects model that showed (1) TENS along with other physical therapy treatments was more effective in reducing spasticity in the lower limbs compared to placebo TENS (SMD −0.64; 95% confidence interval [95% CI], −0.98 to −0.31; P=.0001; I 2 =17%); and (2) TENS, when administered along with other physical therapy treatments, was effective in reducing spasticity when compared to other physical therapy interventions alone (SMD −0.83; 95% CI, −1.51 to −0.15; P=.02; I 2 =27%). There were limited studies to evaluate the effectiveness of TENS for upper limb spasticity. Conclusion: There is strong evidence that TENS as an adjunct is effective in reducing lower limb spasticity when applied for more than 30 minutes over nerve or muscle belly in chronic stroke survivors (review protocol registered at PROSPERO: CRD42015020151).

AB - Objectives: (1) To determine the effect of transcutaneous electrical nerve stimulation (TENS) on poststroke spasticity. (2) To determine the effect of different parameters (intensity, frequency, duration) of TENS on spasticity reduction in adults with stroke. (3) To determine the influence of time since stroke on the effectiveness of TENS on spasticity. Data Sources: PubMed, PEDro, CINAHL, Web of Science, CENTRAL, and EMBASE databases were searched from inception to March 2017. Study Selection: Randomized controlled trial (RCT), quasi-RCT, and non-RCT were included if (1) they evaluated the effects of TENS for the management of spasticity in participants with acute or subacute or chronic stroke using clinical and neurophysiological tools; and (2) TENS was delivered either alone or as an adjunct to other treatments. Data Extraction: Two authors independently screened and extracted data from 15 of the 829 studies retrieved through the search using a pilot tested pro forma. Disagreements were resolved through discussion with other authors. Quality of studies was assessed using Cochrane risk of bias criteria. Data Synthesis: Meta-analysis was performed using a random-effects model that showed (1) TENS along with other physical therapy treatments was more effective in reducing spasticity in the lower limbs compared to placebo TENS (SMD −0.64; 95% confidence interval [95% CI], −0.98 to −0.31; P=.0001; I 2 =17%); and (2) TENS, when administered along with other physical therapy treatments, was effective in reducing spasticity when compared to other physical therapy interventions alone (SMD −0.83; 95% CI, −1.51 to −0.15; P=.02; I 2 =27%). There were limited studies to evaluate the effectiveness of TENS for upper limb spasticity. Conclusion: There is strong evidence that TENS as an adjunct is effective in reducing lower limb spasticity when applied for more than 30 minutes over nerve or muscle belly in chronic stroke survivors (review protocol registered at PROSPERO: CRD42015020151).

UR - http://www.scopus.com/inward/record.url?scp=85058783512&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85058783512&partnerID=8YFLogxK

U2 - 10.1016/j.apmr.2018.10.016

DO - 10.1016/j.apmr.2018.10.016

M3 - Review article

VL - 100

SP - 751

EP - 768

JO - Archives of Physical Medicine and Rehabilitation

JF - Archives of Physical Medicine and Rehabilitation

SN - 0003-9993

IS - 4

ER -