Does the use of TENS increase the effectiveness of exercise for improving walking after stroke? A randomized controlled clinical trial

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Objective:To investigate whether surface electrical stimulation can increase the effectiveness of task-related exercises for improving the walking capacity of patients with chronic stroke.Design:Randomized, placebo-controlled clinical trial.Setting:Home-based programme.Subjects:One hundred and nine hemiparetic stroke survivors were assigned randomly to: (1) transcutaneous electrical nerve stimulation (TENS), (2) TENS + exercise, (3) placebo stimulation + exercise, or (4) control group. Interventions: The TENS group received 60 minutes of electrical stimulation. Both the TENS + exercise group and placebo stimulation + exercise group did 60 minutes of exercises, followed respectively by 60 minutes of electrical and placebo stimulation. Treatment was given five days a week for four weeks. The control group had no active treatment.Outcome measures:Comfortable gait speed was measured using a GAITRite II walkway system. Walking endurance and functional mobility were measured by the distance covered during a 6-minute walk test (6MWT) and by timed up and go test scores before treatment, after two weeks and after four weeks of treatment, and at follow-up four weeks after treatment ended.Results:When compared with the other three groups, only the combined TENS + exercise group showed significantly greater absolute and percentage increases in gait velocity (by 37.1–57.5%, all P<0.01) and reduction in timed up and go scores (by -14.9 to -23.3%, P<0.01) from week 2 onwards. When compared with the control and TENS groups, only the combined TENS + exercise group covered significantly more distance in the 6MWT (by 22.2–34.7%, P<0.01) from week 2 onwards.Conclusion:TENS can improve the effectiveness of task-related exercise for increasing walking capacity in hemiparetic stroke survivors.

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