Efficacy of Addition of Transcutaneous Electrical Nerve Stimulation to Standardized Physical Therapy in Subacute Spinal Spasticity: A Randomized Controlled Trial

Objective: To study the immediate and short-term efficacy of adding transcutaneous electrical nerve stimulation (TENS) to standardized physical therapy on subacute spasticity within 6 months of spinal cord injury. Design: Randomized controlled trial for 3 weeks. Setting: A university hospital. Participants: Subjects (N=16) with clinically determined spasticity were randomly assigned to either the experimental group (n=8) or the control group (n=8). Intervention: Sixty-minute sessions of TENS over the bilateral common peroneal nerves before 30 minutes of physical therapy for the experimental group and 30 minutes of physical therapy alone for the control group. All patients in both groups had access to standardized rehabilitation care. Main Outcome Measures: The composite spasticity score, which included 3 subscores (ankle jerk, muscle tone, and ankle clonus scores), was used as the primary end point to assess plantar flexor spasticity. These subscores were designated as secondary end points. Serial evaluations were made at baseline before study entry and immediately after the first and last sessions in both groups. Results: On analysis for immediate effects, there was a significant reduction only in the composite spasticity score (mean difference, 1.75; 99% confidence interval [CI], 0.47-3.03; P=.002) in the experimental group, but no significant reduction was observed in all outcome variables in the control group. A significant difference in the composite spasticity score (1.63; 99% CI, 0.14-3.11; P =.006) was observed between the 2 groups. After 15 sessions of treatment, a significant reduction was determined in the composite spasticity score (2.75; 99% CI, 1.31-4.19; P<.001), the muscle tone score (1.75; 99% CI, 0.16-3.34; P=.006), and the ankle clonus score (0.75; 99% CI, 0.18-1.32; P=.003) in the experimental group, whereas none of the outcome variables revealed a significant reduction in the control group. The between-group difference was significant only for the composite spasticity score (2.13; 99% CI, 0.59-3.66; P =.001) and the muscle tone score (1.50; 99% CI, 0.15-2.85; P =.005) after 15 intervention sessions. Conclusion: Addition of TENS to standardized physical therapy had synergistically antispastic action, providing more effective reduction of clinical spasticity. (C) 2014 by the American Congress of Rehabilitation Medicine