A Study On Efficacy Of Neuromuscular Electrical Stimulation And Transcutaneous Nerve Stimulation In Hemiplegic Shoulder Pain

Purpose:The analgesic efficacy of neuromuscular electrical stimulation(NMES) on hemiplegic shoulder pain(HSP) has been confirmed, but whether NMES is superior to transcutaneous nerve stimulation(TENS) in easing HSP is uncertain. It is related to NMES treatment mechanisms on HSP, that is, to solve problems through muscle motor relearning or low frequency electrical analgesic. This prospective and randomized controlled study is the first study to compare the efficacy of NMES and TENS on HSP, trying to demonstrate the pain relief mechanism of NMES on HSP.Methods: 66 subjects are randomized into group NMES(22 cases), TENS(22 cases) or control group(22 cases). NMES(15Hz, pulse width 200μs) were applied to trapezius, supraspinatus and deltoid(medial and posterior bundle) in NMES group, TENS(100Hz, pulse width 100μs) were used in the same area. The treatment session included 20 sets(1 set everyday, 60 min each set, 5 times a week, totally 4 weeks). Conventional rehabilitation program without any stimulation were applied in the control group as well as in the NMES/TENS group. Numerical rating scale(NRS) assessment, active / passive range of motion(AROM/PROM) measurement of shoulder external rotation, flexion and abduction, upper extremity Fugl-Meyer score(UE-FM), Barthel index(BI) and stroke specific quality of life scale(SSQOLS) assessment were assessed at week 0(baseline), week 2, week 4 and week 8 respectively.Results: Finally, 62 subjects are finished the study, NMES(20 cases), TENS(22cases) and control group(20 cases). After 4 weeks of treatment, compared with baseline, NRS scores in NMES, TENS and the control group decrease 2.30,1.41 and 0.60, respectively, with significant difference among the three groups(P = 0.000).Among them, the NMES group,TENS group is superior to the control group, the difference is statistically significant(P=0.000, P=0.42); and the efficacy of NMES group is superior to TENS group, the difference is statistically significant(P=0.043). No significant difference of improvement of AROM/PROM of the shoulder joint, UE-FM score, BI and SSQOLS is observed among the three groups. Nonetheless, in the NMES group, SSQOLS and UE-FM of patients are significantly improved compared to baseline after 4 weeks’ treatment, the difference is statistically significant(P=0.017, P=0.007).Conclusion: TENS and NMES can effectively improve the HSP, and the NMES is superior to TENS. NMES effect is significantly better than TENS in aspect of the maintenance of long-term analgesic. NMES and TENS did not effectively improve the shoulder joint mobility, upper limb function, daily life activity abilities and stroke specific quality of life of HSP patients.