Effect of active TENS versus de-tuned TENS on walking capacity in patients with lumbar spinal stenosis: a randomized controlled trial
Abstract Background context Lumbar spinal stenosis (LSS) leads to diminished blood flow to the spinal nerves causing neurogenic claudication and impaired walking ability. Animal studies have demonstrated increased blood flow to the spinal nerves and spinal cord with superficial para-spinal electrica...
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| Format: | Article |
| Language: | English |
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BMC
2019-06-01
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| Series: | Chiropractic & Manual Therapies |
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| Online Access: | http://link.springer.com/article/10.1186/s12998-019-0245-z |
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| author | Carlo Ammendolia Pierre Côté Y. Raja Rampersaud Danielle Southerst Michael Schneider Aksa Ahmed Claire Bombardier Gillian Hawker Brian Budgell |
| author_facet | Carlo Ammendolia Pierre Côté Y. Raja Rampersaud Danielle Southerst Michael Schneider Aksa Ahmed Claire Bombardier Gillian Hawker Brian Budgell |
| author_sort | Carlo Ammendolia |
| collection | DOAJ |
| description | Abstract Background context Lumbar spinal stenosis (LSS) leads to diminished blood flow to the spinal nerves causing neurogenic claudication and impaired walking ability. Animal studies have demonstrated increased blood flow to the spinal nerves and spinal cord with superficial para-spinal electrical stimulation of the skin. Purpose The aim of this study was to assess the effectiveness of active para-spinal transcutaneous electrical nerve stimulation (TENS) compared to de-tuned TENS applied while walking, on improving walking ability in LSS. Study design This was a two-arm double-blinded (participant and assessor) randomized controlled trial. Patient sample We recruited 104 participants 50 years of age or older with neurogenic claudication, imaging confirmed LSS and limited walking ability. Outcome measures The primary measure was walking distance measured by the self-paced walking test (SPWT) and the primary outcome was the difference in proportions among participants in both groups who achieved at least a 30% improvement in walking distance from baseline using relative risk with 95% confidence intervals. Methods The active TENS group (n = 49) received para-spinal TENS from L3-S1 at a frequency of 65–100 Hz modulated over 3-s intervals with a pulse width of 100–200 usec, and turned on 2 min before the start and maintained during the SPWT. The de-tuned TENS group (n = 51) received similarly applied TENS for 30 s followed by ramping down to zero stimulus and turned off before the start and during the SPWT. Study funded by The Arthritis Society ($365,000 CAN) and salary support for Carlo Ammendolia funded by the Canadian Chiropractic Research Foundation ($500,000 CAN over 5 years). Results From August 2014 to January 2016 a total of 640 potential participants were screened for eligibility; 106 were eligible and 104 were randomly allocated to active TENS or de-tuned TENS. Both groups showed significant improvement in walking distance but there was no significant difference between groups. The mean difference between active and de-tuned TENS groups was 46.9 m; 95% CI (− 118.4 to 212.1); P = 0.57. A total of 71% (35/49) of active TENS and 74% (38/51) of de-tuned TENS participants achieved at least 30% improvement in walking distance; relative risk (RR), 0.96; 95% CI, (0.7 to 1.2) P = 0.77. Conclusions Active TENS applied while walking is no better than de-tuned TENS for improving walking ability in patients with degenerative LSS and therefore should not be a recommended treatment in clinical practice. Registration ClinicalTrials.gov ID: NCT02592642. Registration October 30, 2015. |
| first_indexed | 2024-12-12T08:54:29Z |
| format | Article |
| id | doaj.art-1308f6d6ae6a4960b6fabff5fb81354d |
| institution | Directory Open Access Journal |
| issn | 2045-709X |
| language | English |
| last_indexed | 2024-12-12T08:54:29Z |
| publishDate | 2019-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Chiropractic & Manual Therapies |
| spelling | doaj.art-1308f6d6ae6a4960b6fabff5fb81354d2022-12-22T00:30:02ZengBMCChiropractic & Manual Therapies2045-709X2019-06-0127111010.1186/s12998-019-0245-zEffect of active TENS versus de-tuned TENS on walking capacity in patients with lumbar spinal stenosis: a randomized controlled trialCarlo Ammendolia0Pierre Côté1Y. Raja Rampersaud2Danielle Southerst3Michael Schneider4Aksa Ahmed5Claire Bombardier6Gillian Hawker7Brian Budgell8Institute of Health Policy, Management and Evaluation, University of TorontoInstitute of Health Policy, Management and Evaluation, University of TorontoDepartment of Orthopedics, Toronto Western Hospital, University Health NetworkOccupational and Industrial Orthopaedic Centre, Department of Orthopaedic Surgery, NYU Langone HealthDepartment of Physical Therapy, University of PittsburghRebecca MacDonald Centre for Arthritis & Autoimmune Disease, Mount Sinai HospitalDepartment of Medicine, Division of Rheumatology, University of TorontoDepartment of Medicine, Division of Rheumatology, University of TorontoCanadian Memorial Chiropractic CollegeAbstract Background context Lumbar spinal stenosis (LSS) leads to diminished blood flow to the spinal nerves causing neurogenic claudication and impaired walking ability. Animal studies have demonstrated increased blood flow to the spinal nerves and spinal cord with superficial para-spinal electrical stimulation of the skin. Purpose The aim of this study was to assess the effectiveness of active para-spinal transcutaneous electrical nerve stimulation (TENS) compared to de-tuned TENS applied while walking, on improving walking ability in LSS. Study design This was a two-arm double-blinded (participant and assessor) randomized controlled trial. Patient sample We recruited 104 participants 50 years of age or older with neurogenic claudication, imaging confirmed LSS and limited walking ability. Outcome measures The primary measure was walking distance measured by the self-paced walking test (SPWT) and the primary outcome was the difference in proportions among participants in both groups who achieved at least a 30% improvement in walking distance from baseline using relative risk with 95% confidence intervals. Methods The active TENS group (n = 49) received para-spinal TENS from L3-S1 at a frequency of 65–100 Hz modulated over 3-s intervals with a pulse width of 100–200 usec, and turned on 2 min before the start and maintained during the SPWT. The de-tuned TENS group (n = 51) received similarly applied TENS for 30 s followed by ramping down to zero stimulus and turned off before the start and during the SPWT. Study funded by The Arthritis Society ($365,000 CAN) and salary support for Carlo Ammendolia funded by the Canadian Chiropractic Research Foundation ($500,000 CAN over 5 years). Results From August 2014 to January 2016 a total of 640 potential participants were screened for eligibility; 106 were eligible and 104 were randomly allocated to active TENS or de-tuned TENS. Both groups showed significant improvement in walking distance but there was no significant difference between groups. The mean difference between active and de-tuned TENS groups was 46.9 m; 95% CI (− 118.4 to 212.1); P = 0.57. A total of 71% (35/49) of active TENS and 74% (38/51) of de-tuned TENS participants achieved at least 30% improvement in walking distance; relative risk (RR), 0.96; 95% CI, (0.7 to 1.2) P = 0.77. Conclusions Active TENS applied while walking is no better than de-tuned TENS for improving walking ability in patients with degenerative LSS and therefore should not be a recommended treatment in clinical practice. Registration ClinicalTrials.gov ID: NCT02592642. Registration October 30, 2015.http://link.springer.com/article/10.1186/s12998-019-0245-zIntermittent claudicationLumbar spinal stenosisTranscutaneous electrical nerve stimulation (TENS)WalkingRandomized controlled trialNon-operative treatment |
| spellingShingle | Carlo Ammendolia Pierre Côté Y. Raja Rampersaud Danielle Southerst Michael Schneider Aksa Ahmed Claire Bombardier Gillian Hawker Brian Budgell Effect of active TENS versus de-tuned TENS on walking capacity in patients with lumbar spinal stenosis: a randomized controlled trial Chiropractic & Manual Therapies Intermittent claudication Lumbar spinal stenosis Transcutaneous electrical nerve stimulation (TENS) Walking Randomized controlled trial Non-operative treatment |
| title | Effect of active TENS versus de-tuned TENS on walking capacity in patients with lumbar spinal stenosis: a randomized controlled trial |
| title_full | Effect of active TENS versus de-tuned TENS on walking capacity in patients with lumbar spinal stenosis: a randomized controlled trial |
| title_fullStr | Effect of active TENS versus de-tuned TENS on walking capacity in patients with lumbar spinal stenosis: a randomized controlled trial |
| title_full_unstemmed | Effect of active TENS versus de-tuned TENS on walking capacity in patients with lumbar spinal stenosis: a randomized controlled trial |
| title_short | Effect of active TENS versus de-tuned TENS on walking capacity in patients with lumbar spinal stenosis: a randomized controlled trial |
| title_sort | effect of active tens versus de tuned tens on walking capacity in patients with lumbar spinal stenosis a randomized controlled trial |
| topic | Intermittent claudication Lumbar spinal stenosis Transcutaneous electrical nerve stimulation (TENS) Walking Randomized controlled trial Non-operative treatment |
| url | http://link.springer.com/article/10.1186/s12998-019-0245-z |
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