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No significant differences seen between pulsed electrical stimulation, placebo for knee OA
Fary RE. Arthritis Rheum. 2011. doi: 10.1002/art.30258.
A level 1 study of symptomatic patients with radiographic evidence of knee osteoarthritis shows no significant advantages of pulsed electrical stimulation over placebo at 26 weeks.
In this double-blind study, researchers assessed 70 patients who were randomized to receive either pulsed electrical stimulation (PES) or placebo for the treatment of knee osteoarthritis (OA). All of the patients had mild to moderate symptoms and radiographic evidence of moderate to severe OA.
An intention-to-treat analysis revealed that both groups showed statistically significant improvements using a 100-mm pain visual analog scale (VAS) during the 26-week study. However, the researchers found no significant difference between the groups using this measure. They discovered that 56% of patients in the PES group had a clinically relevant improvement of 20 mm on the pain VAS at 26 weeks compared with 44% of patients in the placebo group, according to the study abstract. The groups also showed similar changes in WOMAC scores for pain, stiffness and function, and SF-36 scores.
This was a study of the effectiveness of pulsed electrical stimulation in the management of osteoarthritis (OA) of the knee. The authors have performed a double-blind, randomized placebo-controlled study of patients with AO of the knee with one group receiving pulsed electrical magnetic stimulation and the other group as a placebo. Their primary outcome was the change in pain over the 26 weeks as measured by a 10 cm visual analog scale.
Although the authors claim that the electrical stimulation was no more effective than placebo, they did find that 56% of the electrical stimulation group achieved a clinically relevant 20 mm improvement in visual analog pain scores as compared to 44% of the controls. To this reviewer, this is a nice difference that one might expect in this small study which to this reviewer is under powered. In fact, when I actually evaluated this type of study, the power for this type of analysis is under 5% which means that they need a much larger patient population if they want to show any difference between the two treatment modalities.
Based on a number of excellent more highly powered studies, this study would not dissuade my usage in clinical practice of this highly desired treatment modality for osteoarthritis of the knee.
– Michael A. Mont, MD
Rubin Institute for Advanced Orthopedics
Sinai Hospital of Baltimore
Baltimore, Maryland
Disclosures: Mont is a consultant for Stryker Orthopaedics and Wright Medical and receives research or institutional support from Biomet, BrainLab, DePuy, Finsbury, Smith & Nephew, and Salient Surgical Technologies.