tens is it effective in reducing spasticity in multiple sclerosis
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TENS: Is it effective in reducing spasticity in Multiple Sclerosis? . The Ayrshire Multiple Sclerosis Service. Caledonian University, Glasgow. The Multiple Sclerosis Society. Linda Miller Senior Physiotherapist. TENS.

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tens is it effective in reducing spasticity in multiple sclerosis
TENS: Is it effective in reducing spasticity in Multiple Sclerosis?

The Ayrshire Multiple Sclerosis Service. Caledonian University, Glasgow.

The Multiple Sclerosis Society.

Linda Miller Senior Physiotherapist

slide2
TENS
  • Transcutaneuos Electrical Nerve Stimulation: Electrical stimulation of low intensity, high frequency with short pulse widths selectively stimulates large diameter (Group II), mechanosensative surface nerve endings.
  • Mechanisms of action: segmental inhibition, release of endogenous opiods, physiological blocking, placebo.
spasticity tens
Spasticity & TENS
  • Evidence of change in neurophysiological measures post TENS.
  • Reduction in spasticity in stroke & SCI.
  • Limited research in MS.
  • Clinical experience of reduction in spasm.
aims of the study
Aims of the study
  • To determine whether TENS was effective in reducing spasticity in Multiple Sclerosis.
  • To determine whether TENS was effective for muscle spasm or pain associated with spasticity.
  • To determine whether application time has an impact on the overall effectiveness of TENS.
  • To establish protocols for future studies
study design
Study Design
  • 32 patients from Ayrshire MS service.
  • Repeated crossover design. Subjects randomly assigned 2 groups
  • All subjects used TENS for 2 weeks, 60 min per day and for 2 weeks, 8 hrs per day.
  • Single blind (assessor).
  • TENS 100Hz, 0.125ms, continuous pulse over quadriceps muscle.
outcome measures
Outcome Measures
  • Demographic data
  • Global Spasticity Score(Ash+PTR+ Clonus)
  • Modified Penne Spasm Score
  • Visual Analogue Score
  • Compliance diary
  • Questionnaire
data analysis
Data Analysis
  • A 2 sample T - test was used to check the comparability of the demographic & baseline variables of the 2 groups (Mann-Whitney:not normal).
  • A 3-factor ANOVA(GSS) used to establish that there was no difference between 2 groups.
  • A paired Wilcoxin was performed on the before & after data (GSS,PSS,VAS) from both groups for 60 min & 8 hrs.
results 1
Results 1
  • No significant difference between the 2 groups for baseline & demographic data
  • No sig diff between the groups (p=0.765)
  • No sig diff in the GSS following TENS (60 min & 8hrs) and in the PSS & VAS following TENS (60 min)
results 2 however
Results 2: However!
  • Mean scores reduced post TENS, with scores reducing following 8hrs >60min TENS.
  • Significant reduction in PSS & VAS following TENS (8hrs) p0.05.
  • Wide variability in all scores : more subjects with scores reduced after 8hrs:60min TENS.
questionnaire results
Questionnaire Results
  • The majority of subjects felt TENS had reduced symptoms (88% for spasm).
  • 72% reported benefits lasting lasting 2-3 days after stopping TENS.
  • 81% indicated they would continue to use TENS. Most preferred to use <8 hrs
  • Long term follow up TENS(9 - 21mths) 56% still using.
conclusion
Conclusion
  • No statistically significant reductions in spasticity although the majority of subjects demonstrated clinically significant reductions.
  • TENS is most effective for spasm & pain associated with spasticity.
  • TENS is more effective when used for longer applications.
  • TENS is well tolerated and easy to use.
slide14

Future ImplicationsThe potential for symptom reduction, combined with reduced medication-related complications and costs makes TENS a treatment worth considering in the overall management of people with mild to moderate spasticity in Multiple Sclerosis.

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