Home-based NMES treatment significantly reduces knee pain & stiffness in OA patients

O.C. Sax et al. found in a study that - Home-based NMES treatment resulted in a clinically meaningful reduction of knee pain, stiffness, and knee functional improvements at week 12 compared with sham NMES treatment.

Knee osteoarthritis (OA) is a widespread and debilitating disease that continues to plague patients. Over the past decade, neuromuscular electrical stimulation (NMES) therapy has shown promise in alleviating knee OA-related symptoms.

A randomized, sham-controlled, double-blind, multicenter trial was conducted with 12-week follow-up in 156 knee OA patients receiving either home-based NMES therapy or a modified low-voltage NMES therapy.

A NMES therapy device (CyMedica Orthopedics NMES therapy, Scottsdale, AZ) was provided to the patients and consisted of a conductive knee garment with a controller (pulse generator), docking receptacle, 2 range-of-motion sensors, and 3 electrodes. The electrodes were designed to be placed on the vastus medialis oblique and rectus femoris muscles of the quadriceps.

Outcome measures including knee pain, stiffness, and functionality were collected at baseline through week 12 after the therapy. The primary endpoint was the percentage change from baseline (PCFB) in the Visual Analog Scale (VAS) pain for a patient-nominated physical activity. Secondary endpoints included VAS for general knee pain, Western Ontario and McMaster Universities Osteoarthritis Index, Knee Injury and Osteoarthritis Outcome Score Joint Replacement, and isometric quadriceps strength test.

A clinically meaningful reduction for VAS Nominated Activity was higher in the per-protocol treatment-compliant NMES group than that in the sham low-voltage NMES group at week 12 (PCFB of 42.8% vs 38.6%, P= .562).

This was similarly true for the Western Ontario and McMaster Universities Osteoarthritis Index pain subscale (PCFBs of 36.8% vs 26.6%, P ¼ .038).

Similar trends and reductions of pain were observed for VAS General, Knee Injury and Osteoarthritis Outcome Score Joint Replacement Pain subscale, and isometric quadriceps strength.

The authors concluded that - The home-based NMES therapy as a nonsurgical treatment used in this study has shown efficacy in the treatment of OA-related knee pain, stiffness, and function. This treatment has the potential to provide suffering patients with a bridge between conservative management and definitive total knee procedures. Given the increasing incidence of patients with knee OA due to improved longevity, the health-care implications are clear. Moreover, as more providers embrace the bundled payment model, the cost-saving potential is imminent with TKA sparing measures like these. Future studies should further explore the low-voltage NMES effects on knee OA as seen in sham group.

Further reading:

A Novel Mobile App-Based Neuromuscular Electrical Stimulation Therapy for Improvement of Knee Pain, Stiffness, and Function in Knee Osteoarthritis: A Randomized Trial

Oliver C. Sax et al

Arthroplasty Today 15 (2022) 125-131

https://doi.org/10.1016/j.artd.2022.03.007