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- Title
Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Transcutaneous Electrical Nerve Stimulation (TENS) for Chronic Primary Low Back Pain in Adults.
- Authors
Verville, Leslie; Hincapié, Cesar A.; Southerst, Danielle; Yu, Hainan; Bussières, André; Gross, Douglas P.; Pereira, Paulo; Mior, Silvano; Tricco, Andrea C.; Cedraschi, Christine; Brunton, Ginny; Nordin, Margareta; Connell, Gaelan; Shearer, Heather M.; Wong, Jessica J.; Hofstetter, Léonie; Romanelli, Andrew; Guist, Brett; To, Daphne; Stuber, Kent
- Abstract
Purpose: To evaluate benefits and harms of transcutaneous electrical nerve stimulation (TENS) for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. Methods: We searched for randomized controlled trials (RCTs) from various electronic databases from July 1, 2007 to March 9, 2022. Eligible RCTs targeted TENS compared to placebo/sham, usual care, no intervention, or interventions with isolated TENS effects (i.e., combined TENS with treatment B versus treatment B alone) in adults with CPLBP. We extracted outcomes requested by the WHO Guideline Development Group, appraised the risk of bias, conducted meta-analyses where appropriate, and graded the certainty of evidence using GRADE. Results: Seventeen RCTs (adults, n = 1027; adults ≥ 60 years, n = 28) out of 2010 records and 89 full text RCTs screened were included. The evidence suggested that TENS resulted in a marginal reduction in pain compared to sham (9 RCTs) in the immediate term (2 weeks) (mean difference (MD) = -0.90, 95% confidence interval -1.54 to -0.26), and a reduction in pain catastrophizing in the short term (3 months) with TENS versus no intervention or interventions with TENS specific effects (1 RCT) (MD = -11.20, 95% CI -17.88 to -3.52). For other outcomes, little or no difference was found between TENS and the comparison interventions. The certainty of the evidence for all outcomes was very low. Conclusions: Based on very low certainty evidence, TENS resulted in brief and marginal reductions in pain (not deemed clinically important) and a short-term reduction in pain catastrophizing in adults with CPLBP, while little to no differences were found for other outcomes.
- Subjects
LUMBAR pain; WORLD Health Organization; CINAHL database; MEDICAL databases; META-analysis; MEDICAL information storage &; retrieval systems; CONFIDENCE intervals; SYSTEMATIC reviews; PHYSICAL therapy; MEDICAL protocols; DESCRIPTIVE statistics; RESEARCH funding; MEDLINE; TRANSCUTANEOUS electrical nerve stimulation; ADULTS
- Publication
Journal of Occupational Rehabilitation, 2023, Vol 33, Issue 4, p651
- ISSN
1053-0487
- Publication type
Article
- DOI
10.1007/s10926-023-10121-7