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Burgess L, Babber A, Shalhoub J, Smith S, de la Rosa CN, Fiorentino F, Braithwaite B, Chetter IC, Coulston J, Gohel MS, Hinchliffe R, Stansby G, Davies AH. Neuromuscular Electrical Stimulation for Intermittent Claudication (NESIC): multicentre, randomized controlled trial. Br J Surg 2023; 110:1785-1792. [PMID: 37748866 PMCID: PMC10638544 DOI: 10.1093/bjs/znad299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/15/2023] [Accepted: 08/25/2023] [Indexed: 09/27/2023]
Abstract
METHODS This was an open, multicentre, randomized controlled trial. Patients with intermittent claudication attending vascular surgery outpatient clinics were randomized (1:1) to receive either neuromuscular electrical stimulation (NMES) or not in addition to local standard care available at study centres (best medical therapy alone or plus supervised exercise therapy (SET)). The objective of this trial was to investigate the clinical efficacy of an NMES device in addition to local standard care in improving walking distances in patients with claudication. The primary outcome was change in absolute walking distance, measured by a standardized treadmill test at 3 months. Secondary outcomes included intermittent claudication (IC) distance, adherence, quality of life, and haemodynamic changes. RESULTS Of 200 participants randomized, 160 were included in the primary analysis (intention to treat, Tobit regression model). The square root of absolute walking distance was analysed (due to a right-skewed distribution) and, although adjunctive NMES improved it at 3 months, no statistically significant effect was observed. SET as local standard care seemed to improve distance compared to best medical therapy at 3 months (3.29 units; 95 per cent c.i., 1.77 to 4.82; P < 0.001). Adjunctive NMES improved distance in mild claudication (2.88 units; 95 per cent c.i., 0.51 to 5.25; P = 0.02) compared to local standard care at 3 months. No serious adverse events relating to the device were reported. CONCLUSION Supervised exercise therapy is effective and NMES may provide further benefit in mild IC.This trial was supported by a grant from the Efficacy and Mechanism Evaluation Program, a Medical Research Council and National Institute for Health and Care Research partnership. Trial registration: ISRCTN18242823.
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Affiliation(s)
- Laura Burgess
- Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Adarsh Babber
- Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Joseph Shalhoub
- Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Sasha Smith
- Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
| | | | - Francesca Fiorentino
- Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Clinical Trials Unit, Imperial College London, London, UK
- Nightingale-Saunders Clinical Trials & Epidemiology Unit (King’s Clinical Trials Unit), King’s College London, London, UK
| | - Bruce Braithwaite
- One Stop Vascular Clinic, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Ian C Chetter
- Academic Vascular Surgical Unit, Hull York Medical School, University of Hull/Hull University Teaching Hospital NHS Trust, Hull, UK
| | - James Coulston
- Department of Vascular Surgery, Somerset NHS Foundation Trust, Taunton, UK
| | - Manjit S Gohel
- Department of Vascular Surgery, Cambridge University Hospitals NHS Foundation Trust, & NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Robert Hinchliffe
- Department of Vascular Surgery, North Bristol NHS Trust, Bristol, UK
| | - Gerard Stansby
- Northern Vascular Unit, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Alun H Davies
- Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
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Blaise S, Sinniger V, Seinturier C. Literature review of transcutaneous electrical nerve stimulation in peripheral arterial occlusive disease of the lower limbs. JOURNAL DE MEDECINE VASCULAIRE 2023; 48:116-123. [PMID: 37914456 DOI: 10.1016/j.jdmv.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/20/2023] [Indexed: 11/03/2023]
Abstract
The therapeutic challenge in peripheral arterial occlusive disease (PAD) is often to increase walking distance, improve pain or heal a wound when PAD is symptomatic. Walking rehabilitation or surgical revascularization techniques are limited. Others strategies as alternatives and/or complementary treatments are needed. Among alternative options, Transcutaneous Electrical Nerve Stimulations (TENS) could be of interest, both for improved walking distance or pain reduction. The Transcutaneous Electrical Nerve Stimulation (TENS) is a non-pharmacological, mini-invasive technique involving transcutaneous electrical stimulation. However, there are other transcutaneous electrical nerve stimulation techniques based on the principle of vagus nerve stimulation with different mechanistics. Trans-auricular Vagus nerve stimulation (Ta-VNS) is another TENS technique (electrode on the external ear) which relies on the anti-inflammatory pathways of efferent and afferent vagal fibers. We propose here to review the literature of mini-invasive electrical stimulations, whatever the anatomical zone concerned, in PAD. METHOD The aim was to evaluate the use of non-invasive transcutaneous electrical stimulation therapies (regardless of location) in PAD of the lower limbs, whatever the disease grade. A review of the literature was carried out via a search of the MEDLINE/PubMed database from 1975 to 2023. The articles were selected via abstracts by checking (1) medical indications: PAD patients with claudication were retained, excluding neurological or venous claudication, PAD whatever the disease grade (intermittent claudication or critical limb ischemia [CLI]) and (2) non invasive electrical stimulations were considered (neuromuscular electrical stimulation and spinal cord stimulation were excluded) whatever the anatomical site. Non-electrical stimuli such as acupuncture and reflexotherapy were excluded. RESULTS Only 9 items were selected, including 7 studies with TENS treatment on the calf, one with trans-auricular vagus nerve stimulation and one with electro-acupuncture points of stimulation. CONCLUSION Even if the mechanisms involved are different, TENS on the calves or in the external ears show an improvement of walking distance in PAD patients with intermittent claudication. The results of the studies show few positive effects in arteriopathy but we should keep vigilant in the technics used since mechanisms are different and not fully understood. Electro-stimulation of the calf and external ear appears to be an easy-to-use and accessible therapeutic option, especially since some PAD patients are still failing to be released from pain, despite the rise of endovascular interventional techniques.
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Affiliation(s)
- S Blaise
- Service de médecine vasculaire, Grenoble University Hospital, BP 217, 38043 Grenoble Cedex 09, France; Université de Grenoble Alpes, Inserm U1300, HP2, Grenoble, France.
| | - V Sinniger
- Université de Grenoble Alpes, U1216, Grenoble Institut des Neurosciences, CHU deGrenoble Alpes, 38000 Grenoble, France
| | - C Seinturier
- Service de médecine vasculaire, Grenoble University Hospital, BP 217, 38043 Grenoble Cedex 09, France
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Le Faucheur A, Jéhannin P, Chanteau A, Blanc-Petitjean P, Donnelly A, Hoffmann C, Henni S, Bura-Rivière A, Kaladji A, Lanéelle D, Mahé G. A Multicenter, Investigator-Blinded, Randomized Controlled Trial to Assess the Efficacy of Calf Neuromuscular Electrical Stimulation Program on Walking Performance in Peripheral Artery Disease: The ELECTRO-PAD Study Protocol. J Clin Med 2022; 11:jcm11247261. [PMID: 36555879 PMCID: PMC9784261 DOI: 10.3390/jcm11247261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/23/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
This paper describes a currently on-going multicenter, randomized controlled trial designed to assess the efficacy of calf neuromuscular electrical stimulation (NMES) on changes in maximal walking distance in people with lower extremity peripheral artery disease (PAD), compared with a non-intervention control-group. This study (NCT03795103) encompasses five participating centers in France. PAD participants with a predominant claudication at the calf level and a maximal treadmill walking distance ≤300 m are randomized into one of the two groups: NMES group or Control group. The NMES program consists of a 12-week program of electrical stimulations at the calf-muscle level. The primary outcome of the study is the change in maximal treadmill walking distance at 12 weeks. Main secondary outcomes include changes in the pain-free treadmill walking distance; 6 min total walking distance; global positioning system (GPS)-measured outdoor walking capacity; daily physical activity level by accelerometry; self-reported walking impairment; self-reported quality of life; ankle-brachial index; and skin microvascular function, both at the forearm and calf levels. Recruitment started in September 2019 and data collection is expected to end in November 2022.
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Affiliation(s)
- Alexis Le Faucheur
- Clinical Investigation Center, INSERM, CIC 1414, F-35033 Rennes, France
- Univ. Rennes, M2S—EA 7470, F-35000 Rennes, France
| | - Pierre Jéhannin
- Clinical Investigation Center, INSERM, CIC 1414, F-35033 Rennes, France
- Univ. Rennes, F-35000 Rennes, France
| | | | | | - Alan Donnelly
- PESS Department, Health Research Institute, University of Limerick, V94 T9PX Limerick, Ireland
| | | | - Samir Henni
- Vascular Medicine Department, CHU Angers, F-49000 Angers, France
- UMR CNRS 6015, INSERM 1083, Univ. Angers, F-49000 Angers, France
| | | | - Adrien Kaladji
- Vascular Surgery Unit, CHU Rennes, University Hospital, F-35033 Rennes, France
| | - Damien Lanéelle
- Vascular Medicine Unit, CHU Caen-Normandie, University Hospital, F-14033 Caen, France
| | - Guillaume Mahé
- Clinical Investigation Center, INSERM, CIC 1414, F-35033 Rennes, France
- Univ. Rennes, M2S—EA 7470, F-35000 Rennes, France
- Univ. Rennes, F-35000 Rennes, France
- Vascular Medicine Unit, CHU Rennes, University Hospital, F-35033 Rennes, France
- Correspondence: ; Tel.: +33-299-289-672
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Guilleron C, Durand S, Maktouf W, Henni S, Abraham P, Beaune B. Rearfoot-forefoot profile defined by vertical ground reaction forces during gait is altered in patients with unilateral intermittent claudication. J Biomech 2020; 109:109966. [DOI: 10.1016/j.jbiomech.2020.109966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 10/23/2022]
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Báez-Suárez A, Martín-Castillo E, García-Andújar J, García-Hernández JÁ, Quintana-Montesdeoca MP, Loro-Ferrer JF. Evaluation of different doses of transcutaneous nerve stimulation for pain relief during labour: a randomized controlled trial. Trials 2018; 19:652. [PMID: 30477529 PMCID: PMC6258317 DOI: 10.1186/s13063-018-3036-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 11/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pain during labour is one of the most intense pain that women may experience in their lifetime. There are several non-pharmacological analgesic methods to relieve pain during labour, among them transcutaneous electrical nerve stimulation (TENS). TENS is a low-frequency electrotherapy technique, analgesic type, generally used in musculoskeletal pathology, but it has also come to be used as an alternative treatment during labour. The purpose of this study is to investigate the pain-relieving effect of a TENS application during labour and to find out the most effective dose. METHODS This study is a randomized, double-blind, placebo-controlled trial. TENS therapy was initiated at the beginning of the active phase of labour. Participants were randomly assigned to three groups (21 per group: two active TENS and one placebo). Active TENS 1 intervention consisted in a constant frequency of 100-Hz, 100-μs, active TENS 2 intervention consisted in a varying high-frequency (80-100 Hz), 350 μs, and in a placebo group, participants were connected to the TENS unit without electrical stimulation. TENS was applied with two self-adhesive electrodes placed parallel to the spinal cord (T10-L1 and S2-S4 levels). The primary outcome was pain intensity (0-10 cm) measured on a visual analogue scale (VAS) at several stages (at baseline and at 10 and 30 min later). Secondary outcomes included women's satisfaction (via the Care in Obstetrics: Measure for Testing Satisfaction scale). RESULTS Sixty-three women participated. Regarding baseline characteristics, no differences were found among the three groups. The active TENS 2 group obtained an improvement with clinically significant VAS results (- 2.9, 95% confidence interval - 4.1 to - 1.6, p < 0.001). Regarding satisfaction, the results also revealed better results in the active TENS than in the placebo group. CONCLUSIONS TENS with high frequencies modified in time as well as high pulse width are effective for relieving labour pain, and they are well considered by pregnant participants. TRIAL REGISTRATION ClinicalTrials.gov, NCT03137251 . Registered on 2 May 2017.
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Affiliation(s)
- Aníbal Báez-Suárez
- Department of Medical and Surgical Sciences, University of Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe, s/n, 35016 Las Palmas de Gran Canaria, Las Palmas, Spain.
| | - Estela Martín-Castillo
- Department of Medical and Surgical Sciences, University of Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe, s/n, 35016 Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Josué García-Andújar
- Department of Medical and Surgical Sciences, University of Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe, s/n, 35016 Las Palmas de Gran Canaria, Las Palmas, Spain
| | - José Ángel García-Hernández
- Department of Medical and Surgical Sciences, University of Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe, s/n, 35016 Las Palmas de Gran Canaria, Las Palmas, Spain
| | - María P Quintana-Montesdeoca
- Department of Medical and Surgical Sciences, University of Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe, s/n, 35016 Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Juan Francisco Loro-Ferrer
- Department of Medical and Surgical Sciences, University of Las Palmas de Gran Canaria, Paseo Blas Cabrera Felipe, s/n, 35016 Las Palmas de Gran Canaria, Las Palmas, Spain
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