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Efficacy of addition of transcutaneous electrical nerve stimulation to standardized physical therapy in subacute spinal spasticity

ARCH PHYS MED REHABIL , 2014, vol. 95, n° 11, p. 2013-2020
Doc n°: 171922
Localisation : Documentation IRR

D.O.I. : http://dx.doi.org/DOI:10.1016/j.apmr.2014.06.001
Article consultable sur : http://www.archives-pmr.org

OBJECTIVE: To study the immediate and short-term efficacy of adding
transcutaneous electrical nerve stimulation (TENS) to standardized physical
therapy on subacute spasticity within 6 months of spinal cord injury. DESIGN:
Randomized controlled trial for 3 weeks. SETTING:
A university hospital.
PARTICIPANTS: Subjects (N=16) with clinically determined spasticity were randomly
assigned to either the experimental group (n=8) or the control group (n=8).
INTERVENTION: Sixty-minute sessions of TENS over the bilateral common peroneal
nerves before 30 minutes of physical therapy for the experimental group and 30
minutes of physical therapy alone for the control group. All patients in both
groups had access to standardized rehabilitation care. MAIN OUTCOME MEASURES: The
composite spasticity score, which included 3 subscores (ankle jerk, muscle tone,
and ankle clonus scores), was used as the primary end point to assess plantar
flexor spasticity. These subscores were designated as secondary end points.
Serial evaluations were made at baseline before study entry and immediately after
the first and last sessions in both groups. RESULTS: On analysis for immediate
effects, there was a significant reduction only in the composite spasticity score
(mean difference, 1.75; 99% confidence interval [CI], 0.47-3.03; P=.002) in the
experimental group, but no significant reduction was observed in all outcome
variables in the control group. A significant difference in the composite
spasticity score (1.63; 99% CI, 0.14-3.11; P=.006) was observed between the 2
groups. After 15 sessions of treatment, a significant reduction was determined in
the composite spasticity score (2.75; 99% CI, 1.31-4.19; P<.001), the muscle tone
score (1.75; 99% CI, 0.16-3.34; P=.006), and the ankle clonus score (0.75; 99%
CI, 0.18-1.32; P=.003) in the experimental group, whereas none of the outcome
variables revealed a significant reduction in the control group. The
between-group difference was significant only for the composite spasticity score
(2.13; 99% CI, 0.59-3.66; P=.001) and the muscle tone score (1.50; 99% CI,
0.15-2.85; P=.005) after 15 intervention sessions. CONCLUSION: Addition of TENS
to standardized physical therapy had synergistically antispastic action,
providing more effective reduction of clinical spasticity.
CI - Copyright (c) 2014 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS

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