Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil.
Physiother Res Int. 2024 Jan;29(1):e2062. doi: 10.1002/pri.2062. Epub 2023 Nov 5.
OBJECTIVE: This study examined the effectiveness of neuromuscular electrical stimulation (NMES) added to the exercise or superimposed on voluntary contractions on patient-reported outcomes measures (PROMs) in people with knee osteoarthritis (OA). METHODS: This systematic review was described according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials (RCTs) were obtained from a systematic literature search in five electronic databases (PubMed, PEDro, LILACS, EMBASE, and SPORTDiscus) in April 2022. We described the effects of intervention according to each PROMs (scores for Pain; Self-reported functional ability; Symptoms (hear clicking, swelling, catching, restricted range of motion, and stiffness); Daily living function; Sports function; and Quality of life) and used a random-effect model to examine the impact of NMES plus exercise on pain compared with exercise in people with knee OA. RESULTS: Six RCTs (n = 367) were included. In the qualitative synthesis, the systematic literature analysis showed improvement in pain after NMES plus exercise compared with exercise alone in three studies. The other three studies revealed no difference between groups in pain, although similar improvement after treatments. In the meta-analysis, NMES at a specific joint angle combined with exercise was not superior to exercise alone in pain management (standardized mean difference = -0.33, 95% CI = -1.05 to 0.39, p = 0.37). There was no additional effect of NMES on exercise on self-reported functional ability, stiffness, and physical function compared with exercise alone. In only one study, symptoms, activities of daily living, sports function, and quality of life improved after whole-body electrostimulation combined with exercise. CONCLUSION: This review found insufficient evidence for the effectiveness of NMES combined with exercise in treating knee OA considering PROMs. While pain relief was observed in some studies, more high-quality clinical trials are needed to support the use of NMES added to the exercise in clinical practice. Electrical stimulation in a whole-body configuration combined with exercise shows promise as an alternative treatment option.
目的：本研究旨在探讨神经肌肉电刺激（NMES）在膝关节骨关节炎（OA）患者中，附加于运动或叠加于自主收缩对患者报告结局测量（PROMs）的有效性。
方法：本系统评价根据系统评价和荟萃分析首选报告项目（PRISMA）指南进行描述。2022 年 4 月，我们通过对五个电子数据库（PubMed、PEDro、LILACS、EMBASE 和 SPORTDiscus）进行系统文献检索，获得了随机对照试验（RCT）。我们根据每个 PROMs（疼痛评分、自我报告的功能能力、症状（听到咔哒声、肿胀、卡住、运动范围受限和僵硬）、日常生活功能、运动功能和生活质量）描述了干预的效果，并使用随机效应模型来检查 NMES 加运动与运动对膝关节 OA 患者疼痛的影响。
结果：纳入了 6 项 RCT（n=367）。在定性综合分析中，系统文献分析显示，在三项研究中，NMES 加运动组在疼痛方面的改善优于单纯运动组。另外三项研究则表明，两组在疼痛方面没有差异，尽管治疗后都有类似的改善。在荟萃分析中，特定关节角度的 NMES 与运动相结合在疼痛管理方面并不优于单独运动（标准化均数差=-0.33，95%置信区间=-1.05 至 0.39，p=0.37）。与单独运动相比，NMES 对自我报告的功能能力、僵硬和身体功能没有额外的运动效果。只有一项研究显示，全身电刺激结合运动后，症状、日常生活活动、运动功能和生活质量得到改善。
结论：考虑到 PROMs，本综述发现 NMES 结合运动治疗膝 OA 的有效性证据不足。虽然一些研究观察到了疼痛缓解，但仍需要更多高质量的临床试验来支持在临床实践中添加 NMES 运动。全身配置的电刺激结合运动显示出作为替代治疗选择的潜力。
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