在膝骨关节炎患者的教育与运动计划中加入经颅直流电刺激（tDCS）和经皮电刺激神经疗法（TENS）：一项研究方案。
Addition of tDCS and TENS to an education and exercise program in subjects with knee osteoarthritis: A study protocol.
作者信息
Gacto-Sánchez Mariano, Lozano-Meca José Antonio, Lozano-Guadalajara Juan Vicente, Baño-Alcaraz Aitor, Lillo-Navarro Carmen, Montilla-Herrador Joaquina
机构信息
Departament of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum (CMN), University of Murcia, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, Spain.
Rehabilitation Service, Morales Meseguer University Hospital, Murcia, Spain.
出版信息
J Back Musculoskelet Rehabil. 2023;36(2):299-307. doi: 10.3233/BMR-220015.
BACKGROUND
Knee osteoarthritis often leads to chronic pain that frequently becomes disabling.Osteoarthritis has been linked to maladaptive plasticity in the brain, which can contribute to chronic pain. Therapies including neuromodulation and peripheral electrical stimulation are used to counteract the maladaptive plasticity of the brain.
OBJECTIVE
To determine the efficacy of the addition of tDCS and TENS to an education and exercise program in reducing pain.
METHODS
Over a 2-week study period, 60 participants will complete an exercise and educational intervention. Eligible participants accepting to participate will be subsequently randomized into one of the three treatment groups: 1) Active Transcranial Direct Current Stimulation (tDCS) and active Transcutaneous Electrical Nerve Stimulation (TENS); 2) Active tDCS and sham TENS; 3) Sham tDCS and sham TENS.
RESULTS
The primary outcome will be subjective pain intensity.
SECONDARY OUTCOMES
quality of life, physical function, central sensitization, and pain adjuvants (uncertainty, catastrophizing kinesiophobia, adverse events).
CONCLUSION
This clinical trial will provide data on the effect that the addition of tDCS and/or TENS to an education and exercise program may have to counteract maladaptive plastic changes and improve the benefits of exercises, and whether the combination of both neuromodulator techniques may have a higher magnitude of effect.
背景
膝关节骨关节炎常导致慢性疼痛，且这种疼痛往往会使人致残。骨关节炎与大脑中的适应性不良可塑性有关，而这可能会导致慢性疼痛。包括神经调节和外周电刺激在内的治疗方法被用于对抗大脑的适应性不良可塑性。
目的
确定在教育和运动计划中添加经颅直流电刺激（tDCS）和经皮电刺激神经疗法（TENS）在减轻疼痛方面的疗效。
方法
在为期2周的研究期间，60名参与者将完成一项运动和教育干预。接受参与的符合条件的参与者随后将被随机分为三个治疗组之一：1）主动经颅直流电刺激（tDCS）和主动经皮电刺激神经疗法（TENS）；2）主动tDCS和假TENS；3）假tDCS和假TENS。
结果
主要结局将是主观疼痛强度。
次要结局
生活质量、身体功能、中枢敏化和疼痛辅助因素（不确定性、灾难化、运动恐惧、不良事件）。
结论
这项临床试验将提供数据，说明在教育和运动计划中添加tDCS和/或TENS可能对对抗适应性不良的塑性变化和提高运动益处产生的效果，以及这两种神经调节技术的组合是否可能产生更大程度的效果。
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