Professional Documents
Culture Documents
The objective of this study was to examine the short- and long-term effects of a home-based, 12-week
neuromuscular electrical stimulation (NMES) of the quadriceps femoris to decrease arthritis knee pain in
older adults with osteoarthritis of the knee. The study sample (N ⫽ 38) was randomly assigned to the
NMES treatment plus education group or the arthritis education-only group. Pain was measured in both
groups with the McGill Pain Questionnaire (MPQ) at baseline, during the intervention at weeks 4, 8, 12,
and at follow-up and with the Arthritis Impact Measurement Scale 2–Pain Subscale (AIMS2-PS) at
baseline and week 12. The NMES Pain Diary (PD) was completed 15 minutes before and after each
stimulation session. There was a significant 22% decline in pain 15 minutes after as compared with
immediately before each NMES treatment (p ⬍ .001), as measured by the PD. No significant group
differences were found between the 2 groups over the course of the intervention and follow-up. These
findings indicate that a home-based NMES intervention reduced arthritis knee pain 15 minutes after a
NMES treatment.
© 2004 Elsevier Inc. All rights reserved.
Applied Nursing Research, Vol. 17, No. 3 ( August), 2004: pp 201-206 201
202 GAINES, METTER, AND TALBOT
Table 1. Comparison of Demographics and Physical Characteristics Between the NMES and
Education-Only Groups
Variable NMES (n ⫽ 20) Education (n ⫽ 18) p
use of NMES reported by Moore and Shurman ment in pain was found for either the NMES or
(1997) and analogous to the pain relief reported education interventions.
with the use of TENS (Jensen et al., 1991; Zizic et The immediate decline in pain may be caused by
al., 1995). However, similar to the results reported the transcutaneous transmission of electrical cur-
by Oldham et al. (1995), no long-term improve- rent stimulating the large-diameter afferent nerve
fibers that inhibit second-order neurons in the dor-
sal horn. This prevents nociceptive impulses from
reaching the higher brain centers, specifically the
periaquaductal gray matter and the thalamus
(Sluka, Deacon, Stibal, Strissel, & Terpstra, 1999).
Abbreviations: NMES, neuromuscular electrical stimulation experimental group; PPI, present pain intensity; PRIT, Pain Rating
Index–Total; SS, sum of squares; MS, mean square.
A second mechanism of pain relief may occur minutes after stimulation. Using battery-powered
through activation of the endogenous opioid sys- units, this home-based program is safe, feasible,
tem with the release of endorphins (Hoffmann, and well accepted by older individuals with knee
Carlsson, & Thoren, 1990; Sluka et al., 1999). OA. Through further testing, this method may
However, a placebo effect cannot be discounted. prove to be one component in an arsenal of meth-
Participants in the NMES protocol self-reported ods nurses use to relieve arthritis knee pain.
completing 81.82% of stimulation sessions. A hid-
den compliance monitor with the stimulation de-
vice recording a mean of 7.88 hours (SD ⫽ 3.07)
of the 9 hours of possible stimulation for an ad- These preliminary results suggest
herence rate of 87.5%. However, because this was that a home-based protocol of NMES
a home-based protocol, it is possible that partici- improves arthritis pain 15 minutes af-
pants adjusted the electrical stimulation to a lower
level thereby reducing the intensity of the contrac-
ter stimulation.
tion and the pain-relieving effects of the stimula-
tion. Within the NMES protocol, only the partici-
pant’s index leg was stimulated producing pain CONCLUSION
relief. Participants frequently stated they had pain Within this study, there was an immediate de-
in both knees. The treatment of one leg may not be cline in arthritis knee pain that occurred when
enough to overcome the pain from the second leg NMES was used only 15 minutes/d, 3 days/wk
and the participant would continue to report little with parameters set for muscle strengthening.
or no change in pain. NMES, as used in this study, was a low-risk, rel-
Generalizability in this study is limited to com- atively low-cost strategy that can be taught and
munity-dwelling older adults with osteoarthritis of monitored by nurses. This study has provided the
the knee functionally able and willing to attend a preliminary support for continuing research into
local senior center. In this sample, men were un- the use of the electrical stimulator among people
derrepresented. Although this study had 13% mi- with osteoarthritis of the knee.
nority representation, all were women.
Acknowledgments
IMPLICATIONS FOR NURSING
We would like to thank Drs Shari Ling and Rob McKinney
These preliminary results suggest that a home- for screening the participants and our research assistant Trina
based protocol of NMES improves arthritis pain 15 Duke. We would like to thank the participants in this study.
REFERENCES
Arthritis Foundation. (1996). Arthritis self-help course: lead- M., Monu, J., & Craven, T. (1997). A randomized trial compar-
er’s manual and reference materials. Atlanta, GA: The Arthritis ing aerobic exercise and resistance exercise with a health edu-
Foundation. cation program in older adults with knee osteoarthritis. The
Ettinger, W.H. Jr., Burns, R., Messier, S.P., Applegate, W., Fitness Arthritis and Seniors Trial (FAST). Journal of American
Rejeski, W.J., Morgan, T., Shumaker, S., Berry, M.J., O’Toole, Medical Association, 277(1), 25-31.
206 GAINES, METTER, AND TALBOT
Flores, R.H., & Hochberg, M.C. (1995). Medical management of stimulation for treatment of chronic back pain: A double-blind,
osteoarthritis. Contemporary Internal Medicine, 7(6), 32-3641-32. repeated measures comparison. Archives of Physical Medicine
Hoffmann, P., Carlsson, S., & Thoren, P. (1990). The effects and Rehabilitation, 78(1), 55-60
of mu, delta- and kappa-opioid receptor antagonists on the pain Oldham, J.A., Howe, T.E., Petterson, T., Smith, G.P., &
threshold increase following muscle stimulation in the rat. Acta Tallis, R.C. (1995). Electrotherapeutic rehabilitation of the
Physiologica Scandinavica, 140, 535-538. quadriceps in elderly osteoarthritic patients: A double blind
Jensen, H., Zesler, R., & Christensen, T. (1991). Transcuta- assessment of patterned neuromuscular stimulation. Clinical
neous electrical nerve stimulation (TNS) for painful osteoar- Rehabilitation, 9(1), 10-20.
throsis of the knee. International Journal of Rehabilitation Sluka, K.A., Deacon, M., Stibal, A., Strissel, S., & Terpstra,
Research, 14(4), 356-358. A. (1999). Spinal blockade of opioid receptors prevents the
Lorig, K., Gonzalez, V.M., Laurent, D.D., Morgan, L., & analgesia produced by TENS in arthritic rats. Journal of Phar-
Laris, B.A. (1998). Arthritis self-management program varia- macology and Experimental Therapeutics, 289(2), 840-846.
tions: Three studies. Arthritis Care and Research, 11(6), 448- Talbot, L.A., Gaines, J.M., Ling, S., & Metter, E.J. (2003). A
454. home-based protocol of electrical muscle stimulation improves
Meenan, R.F., Mason, J.H., Anderson, J.J., Guccione, A.A., quadriceps muscle strength in older adults with osteoarthritis of
& Kazis, L.E. (1992). AIMS2. The content and properties of a the knee. Journal of Rheumatology, 30(7), 1571-1578.
revised and expanded Arthritis Impact Measurement Scales United States Department of Health and Human Services.
Health Status Questionnaire. Arthritis and Rheumatism, 35(1), (1999). Current estimates from the National health Interview
1-10. Survey, 1996. Vital and Health Statistics, 10(200), 4, 81.
Melzack, R. (1975). The McGill Pain Questionnaire: Major Zizic, T.M., Hoffman, K.C., Holt, P.A., Hungerford, D.S., &
properties and scoring methods. Pain, 1(3), 277-299. O’Dell, J.R. et al. (1995). The treatment of osteoarthritis of the
Moore, S.R., & Shurman, J. (1997). Combined neuromuscu- knee with pulsed electrical stimulation. Journal of Rheumatol-
lar electrical stimulation and transcutaneous electrical nerve ogy, 22(9), 1757-1761.