Effect of Transcutaneous Electrical Nerve Stimulation (TENS) on spasticity in adults with stroke: A systematic review and meta-analysis

Publication date: Available online 16 November 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Amreen Mahmood, Sundar Kumar Veluswamy, Aditi Hombali, Aditi Mullick, Manikandan N, John M. Solomon

Abstract

Objectives

1. To determine the effect of transcutaneous electrical nerve stimulation (TENS) on post-stroke spasticity. 2a. To determine the effect of different parameters (intensity, frequency, and duration) of TENS on spasticity reduction in adults with stroke; 2b. To determine the influence of time since stroke on the effectiveness of TENS on spasticity.

Data sources

PubMed, PEDro, CINAHL, Web of Science, CENTRAL and EMBASE databases were searched from inception to March 2017.

Study Selection

Randomized controlled trial (RCT), quasi RCT and non-RCT were included if: (a) they evaluated the effects of TENS for the management of spasticity in participants with acute/sub-acute/chronic stroke using clinical and neurophysiological tools; and (b) TENS was delivered either alone or as an adjunct to other treatments.

Data extraction

Two authors independently screened and extracted data from 15 of the 829 studies retrieved through the search using a pilot tested pro-forma. Disagreements were resolved through discussion with other authors. Quality of studies was assessed using Cochrane risk of bias criteria.

Data synthesis

Meta-analysis was performed using a random-effects model which showed (a) TENS along with other physical therapy treatments was more effective in reducing spasticity in the lower limbs compared to placebo TENS (SMD -0.64, 95% CI -0.98 to -0.31; p = 0.0001; I² =17%); and (b) TENS, when administered along with other physical therapy treatments, was effective in reducing spasticity when compared to other physical therapy interventions alone (SMD -0.83, 95% CI -1.51 to -0.15; p =0.02; I² = 27%). There were limited studies to evaluate the effectiveness of TENS for upper limb spasticity.

Conclusion

There is strong evidence that TENS as an adjunct is effective in reducing lower limb spasticity when applied for more than 30 minutes over nerve or muscle belly in chronic stroke survivors. (Review protocol registered at PROSPERO: CRD42015020151).

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