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Electrical stimulation for the treatment of rheumatoid arthritis

  • Review
  • Intervention

Authors


Abstract

Background

Electrical stimulation is one of several rehabilitation interventions suggested for the management of rheumatoid arthritis (RA) to enhance muscle performance.

Objectives

To assess the effectiveness of electrical stimulation for improving muscle strength and function in clients with RA.

Search methods

We searched MEDLINE, Embase, HealthSTAR, Sports Discus, CINAHL, the Cochrane Controlled Trials Register, the PEDro database, the specialized registry of the Cochrane musculoskeletal group and the Cochrane field of physical and related therapies up to January 2002 according to the sensitive search strategy for RCTs designed for the Cochrane Collaboration. The search was complemented with handsearching of the reference lists. Key experts in the area were contacted for further articles.

Selection criteria

All randomized controlled trials (RCTs) and controlled clinical trials (CCTs), case-control and cohort studies comparing ES against placebo or another active intervention in patients with RA were selected, according to an a priori protocol. No language restrictions were applied.

Data collection and analysis

Two independent reviewers determined the studies to be included based on a priori inclusion criteria. Data were independently abstracted by the same two reviewers, and checked by a third reviewer using a pre-developed form. The same two reviewers, using a validated scale, independently assessed the methodological quality of the RCTs and CCTs. The data analysis was performed using Peto Odds ratios.

Main results

Of the two relevant studies that were identified in the literature, only one RCT met the inclusion criteria. This RCT compared the effects of two electrostimulation (ES) protocols on hand function in general and on the performance of the first dorsal interosseous muscle in particular, in 15 patients with RA and secondary disuse atrophy of the first dorsal interosseous of the dominant hand. The results showed that ES had significant benefit when compared to a control no treatment group in terms of muscle strength and fatigue resistance of the first dorsal interosseous. Most favourable results were obtained by using a patterned stimulation derived from a fatigued motor unit of the first dorsal interosseous in a normal hand rather than a fixed 10 Hz stimulation frequency. Side effects of the ES application were not reported.

Authors' conclusions

ES was shown to have a clinically beneficial effect on grip strength and fatigue resistance for RA patients with muscle atrophy of the hand. However, these conclusions are limited by the low methodological quality of the trial included. More well-designed studies are therefore needed to provide further evidence of the benefits of ES in the management of RA.

摘要

背景

電刺激治療類風濕性關節炎

電刺激以增強肌力是治療類風濕性關節炎許多復建方法之一。

目標

評估電刺激治療類風濕性關節炎,以增強肌力及功能。

搜尋策略

搜尋包括MEDLINE, Embase, HealthSTAR, Sports Discus, CINAHL, the Cochrane Controlled Trials Register, the PEDro database, the specialized registry of the Cochrane musculoskeletal group and the Cochrane field of physical and related therapies (直到2002年1月)。同時手動搜尋所選文章之參考文獻及徵詢專家。

選擇標準

所有隨機對照試驗及控制對照研究,病例對照研究、世代研究比較電刺激與安慰劑或另一種治療,對類風濕性關節炎的療效與副作用。

資料收集與分析

兩位作者使用預定條件獨立進行資料摘錄,並由第三位檢查。並對每篇試驗研究的品質進行評估。資料以Peto odds ratios做分析。

主要結論

2篇相關臨床試驗,但其中只有1篇臨床試驗符合納入分析,研究15位因類風濕性關節炎肌肉萎縮患者慣用手之手功能及第一背面指間肌(first dorsal interosseous muscle),結果顯示電刺激組在肌力及抗疲勞有顯著差異。最有效者為刺激正常手的第一背面指間肌使用patterned 刺激而非固定刺激10 Hz頻率。未報告副作用。

作者結論

電刺激在風濕性關節炎肌肉萎縮患者之肌力及疲勞阻力有療效。但結論來自低品質研究,需進一步高品質研究。

翻譯人

本摘要由林口長庚醫院余光輝翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沒有證據支持使用電刺激治療類風濕關節炎。 電刺激(ES)是一個介入治療,可用於治療類風濕關節炎(RA)。具體來說,ES是用來改善肌肉表現,維持或提高日常生活各種功能活動所需要的肌肉力量和耐力。ES在肌肉的效果是經由召喚需要其工作時,因各種因素,包括肌肉廢用性萎縮和關節疼痛等而無法自主啟動的運動元,來加以產生。有關EA在RA的隨機(隨機對照試驗),臨床對照試驗(CCT),病例對照研究和世代研究的review中,只確定了兩個隨機對照試驗,其中只有一個符合標準。這一項隨機對照試驗的結果,涉及15個影響手部的風濕關節炎患者,顯示有顯著的結果贊成使用patterned ES刺激正常手之疲勞的第一背面指間肌,且有助所有觀察指標:握力,捏力和肌肉功能和耐力。相比於無治療的對照組,電刺激傳遞無論使用固定頻率為 10赫茲或patterned頻率,在兩個觀察指標有顯著的效益:捏力和肌肉耐力。但這些結論是有限的,因為較差的ES應用報告和較差的試驗方法學品質。回顧者因此得出結論,在這個時候沒有明確的證據可下結論使用ES在類風濕關節炎

Plain language summary

No evidence to support the use of electrical stimulation in the management of rheumatoid arthritis

Electrical stimulation (ES) is one of the intervention techniques that is available for the management of patients with rheumatoid arthritis (RA). Specifically, ES is used to improve muscle performance, maintaining or enhancing the muscle strength and endurance that is required for the various functional activities of daily living (ADL). The effects of ES on muscle performance are produced by the recruitment of motor units that are not activated voluntarily during a task due to various factors that include muscle disuse atrophy and articular pain.

A review of randomized (RCT) and controlled clinical trials (CCT), case-control and cohort studies of the use of ES in RA only identified two RCTs, only one of which met the criteria for retention. The results of this one RCT, involving 15 patients with RA affecting the hand, showed significant results that favoured the use of patterned ES derived from a fatigued motor unit from the first dorsal interosseous in a normal hand for all outcome measures: grip strength, pinch strength, and muscle function and endurance. Electrical stimulation whether delivered at a fixed frequency of 10 Hz or at patterned frequency, had significant benefit when compared to a no treatment control group on two outcome measures: pinch strength and muscle endurance. These conclusions however are limited by poor reporting of the characteristics of application of the ES and the poor methodological quality of the trial. The reviewers therefore conclude that there is no clear evidence for the inclusion of ES in the management of RA at this time.

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