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Transcutaneous Electrical Nerve Stimulation in Patients With Knee Osteoarthritis: Evidence From Randomized-controlled Trials

Chen, Ling-Xiao MD*; Zhou, Zhi-Rui MD†,‡,‡; Li, Yu-Lin MD*; Ning, Guang-Zhi MD*; Li, Yan MD*; Wang, Xiao-Bo MD*; Feng, Shi-Qing PhD*

doi: 10.1097/AJP.0000000000000233
Original Articles

Objectives: Transcutaneous electrical nerve stimulation (TENS) has been reported to relieve pain and improve function in patients with knee osteoarthritis. The purpose of this systematic review and meta-analysis was to evaluate the efficacy of TENS for the management of knee osteoarthritis.

Methods: We searched Embase, PubMed, CENTRAL, SIGLE, PEDro, and, up to June 2014 for literature related to TENS used for the treatment of knee osteoarthritis. Two authors independently screened the searched records based on the title and abstract. Information including the authors, study design, mean age, sex, study population, stimulation frequency (of TENS), outcome measures, and follow-up periods were extracted by the 2 authors.

Results: Eighteen trials were included in the qualitative systematic review, and 14 were included in the meta-analysis. TENS significantly decreased pain (standard mean difference, −0.79; 95% confidence interval [CI], −1.31 to −0.27; P<0.00001) compared with control groups. There was no significant difference in the Western Ontario and McMaster Universities Osteoarthritis Index (standard mean differences, −0.13; 95% CI, −0.35 to 0.1; P=0.09) or the rate of all-cause discontinuation (risk ratio, 0.77; 95% CI, 0.48 to 1.22; P=0.94) between the TENS and control groups.

Discussion: TENS might relieve pain due to knee osteoarthritis. Further randomized-controlled trials should focus on large-scale studies and a longer duration of follow-up.

Supplemental Digital Content is available in the text.

*Department of Orthopaedics, Tianjin Medical University General Hospital, Heping District, Tianjin

Department of Radiation Oncology, Fudan University Shanghai Cancer Center

Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website,

L.-X.C. and Z.-R.Z. contributed equally.

L.-X.C.: data collection, data analysis, interpretation, and writing the paper; Z.-R.Z., Y.-L.L., and G.-Z.N.: data collection and data analysis; L.-X.C., Z.-R.Z., Y.-L.L., G.-Z.N., Y.L., Q.-L.W., X.-B.W., and S.-Q.F.: study design, interpretation, and commenting on drafts of the paper; and L.-X.C., Z.-R.Z., Y.-L.L., G.-Z.N., Y.L., X.-B.W., S.-Q.F.: read and approved the final manuscript.

The authors declare no conflict of interest.

Reprints: Shi-Qing Feng, PhD, Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin 300052, People’s Republic of China (e-mail:

Received August 29, 2014

Received in revised form April 1, 2015

Accepted March 1, 2015

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