Transcutaneous electrical nerve stimulation therapy for rotator cuff tendinopathy

Study Type: Systematic review
OE Level of Evidence: 3
Journal Level of Evidence: N/A
6 randomized controlled trials (n=271) were included in this systematic review for the purpose of comparing transcutaneous electrical nerve stimulation (TENS) with several other treatments for rotator cuff tendinopathy, including ultrasound therapy, corticosteroid injection, heat therapy, and pulse radiofrequency. Results demonstrated that although significant improvements were achieved by patients treated with TENS when compared to pre-treatment measurements, the majority of clinical outcomes showed comparable improvements between active treatment groups. However, due to Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-Industry funded
Sponsor: Reseau Provincial de Recherche en Adaptation-Readaptation (REPAR), Institut de Recherche en Sante et Securite au Travail (IRSST), and Fonds de Recherche du Quebec en Sante (FRQS).
Conflicts: None disclosed
Why was this study needed now?
Subacromial impingement syndrome, biceps tendinopathy, subdeltoid arthritis, as well as many other shoulder impairments often fall under the breadth of rotator cuff tendinopathy. Due to the wide variety of symptoms and aetiologies, there is an increased need for effective therapy. Transcutaneous electrical nerve stimulation (TENS) is a common feature of physiotherapy in the management of musculoskeletal pain, and it has been suggested that through electrical stimulation of the large non-nociceptive afferent fibres, peripheral inhibition of associated pain can be achieved. Many studies have compared the benefits of TENS in comparison to several therapies, however there is a lack of synthesized and comparative evidence that directly compares TENS with other interventions. Thus, the current systematic analysis was conducted.
What was the principal research question?
For patients with rotator cuff tendinopathy, did transcutaneous electrical nerve stimulation (TENS) result in significantly improved pain, range of motion, and quality of life outcomes when compared to other therapies including ultrasound therapy, corticosteroid injection, heat therapy, and pulse radiofrequency therapy, as assessed up to 12 weeks post-intervention?
Data Source: CINAHL, Embase, PubMed and PeDRO were used to search relevant studies from inception to April 2015. A supplementary search of the reference lists of relevant studies were also searched for potential studies for inclusion.
Index Terms: The index terms searched were rotator cuff, tendinopathy, subacromial impingement syndrome, shoulder pain AND electric stimulation, transcutaneous combined with various MeSH terms.
Study Selection: English of French randomized controlled trials comparing the efficacy of TENS therapy with another intervention, placebo, or no intervention for patients age greater than or equal to 18 years with rotator cuff tendinopathy (or any other related condition including subacromial impingement syndrome, bicipital tendinitis, and subdeltoid bursitis) were included for review. Two independent reviewers reviewed potential articles for inclusion criteria. Studies including patients with calcifying tendinopathy or a full-thickness rotator cuff tear were not included in the review. A total of six randomized controlled trials were selected for inclusion.
Data Extraction: Participant characteristics, interventions, outcomes measures, follow-up duration, co-interventions, and main result data was extracted using a standardised form by one reviewer. Outcomes of interest included pain measured by a visual analogue scale (VAS), shoulder range of motion, Short-Form 36 scores, and requirement of analgesic medication.
Data Synthesis: Kappa statistic and the Cochrane risk of bias tool were used to evaluate preconsensus inter-rater agreement and potential risk of bias of the included studies. Pooling of similar outcome data was attempted through meta-analysis wherever possible. Qualitative review of main findings was performed when analysis could not be performed.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.