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.

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.

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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 strategy: 

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.

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