Effects of Low Frequency TENS and Therapeutic Ultrasound in Post-stroke Shoulder Pain

July 12, 2023 updated by: Riphah International University

Analgesic Effects of Low Frequency Transcutaneous Electrical Stimulation and Therapeutic Ultrasounds on Functional Disability in Post-stroke Shoulder Pain

Brief Summary: Post-Stroke shoulder pain is a well-known complication and is responsible for the reduction in functional outcomes. A number of factors related to post-stroke shoulder pain including shoulder activity limitation, spasticity of shoulder muscles, and shoulder subluxation. Stroke patients may suffer from pain caused by the stroke itself (central post-stroke pain). Physical therapy plays an important role in the management of post-stroke shoulder pain. Different physical therapy techniques and modalities have been used in reducing pain and increasing functional outcomes in post-stroke shoulder pain patients. This study aims to provide a combined analysis of two modalities: low-frequency TENS and Therapeutic Ultrasound in terms of effects on pain and functional disability. This will be a randomized clinical trial to determine the analgesic effect of low-frequency transcutaneous electrical stimulation and therapeutic ultrasound on functional disability in post-stroke shoulder pain. The study will be conducted in accordance with ethical guidelines of Riphah International University and a convenience sampling technique will be used. Patients aged 65-84 years, with a history of pain of more than 4 weeks will be included in our study. Patients having a stroke with other neurological deficits, unstable cardiovascular diseases such as ventricular arrhythmias, and stroke patients with a history of diagnosed frozen shoulder will be excluded from the study. Subjects will be randomly allocated into three groups. Baseline assessment of pain and functional disability of patients will be done using outcome measuring tools and clinical tests. Group A will receive low-frequency TENS and therapeutic Ultrasound as a treatment, group B will receive therapeutic ultrasound and Group C will receive low-frequency TENS as a treatment. The duration of the study will be six weeks and patients will receive a total of 12 treatment sessions (3 sessions per week for 4 weeks and then follow-up will be done for the next 2 weeks) and the duration of each session will be of 20-25 minutes. After 12 sessions, a final assessment will be done and the results will be analyzed. Frequencies and mean standard deviation will be measured, and parametric and non-parametric tests will be applied.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

Cerebral vascular accidents (CVAs) are the second most common cause of death in developed nations, according to the World Health Organization.It is a significant factor in disability because it causes paralysis and cognitive impairments in the population that survives. According to data from the literature, 25% of stroke patients pass away within a few weeks.Shoulder pain is exasperating complication after stroke and responsible for the longer stay in the rehabilitation department. The incidence varies from 9%-40.Post-Stroke shoulder pain decreased functional outcome, and quality of life.Post-stroke muscle weakness and spasticity lead to shoulder instability and immobility. The etiology of shoulder pain after stroke is multifactorial complex regional pain syndrome, shoulder joint subluxation, adhesive capsulitis, spasticity, and shoulder muscles weakness.Etiological intricacy makes it necessary to use a stroke-specific approach rather than always expanding the musculoskeletal knowledge base.

Presence of hemiplegic shoulder pain is strongly associated poor recovery of arm function in the first 12 weeks after stroke.It may be a sign of brachial plexus damage if there are aberrant motor recovery patterns, spasticity or particularly severe localized atrophy. A pre-existing ailment like osteoarthritis may worsen as a result of improper management of a hemiplegic limb. Therefore, hemiplegic shoulder pain may be caused by pre-morbid shoulder illness.Physical therapy has been shown to be very effective in treating post-stroke shoulder pain. A variety of techniques and treatment modalities are use around the world to alleviate the post-stroke shoulder pain. Of particular interest to this research are two electrotherapy modalities low frequency transcutaneous electrical stimulation and Therapeutic Ultrasound will be treatment option.

TENS therapy together with conventional rehabilitation could be used as a good alternative therapy in patients with hemiplegic shoulder pain.There is wide spread use of TENS throughout health care and it is a common treatment modality for musculoskeletal pain. The TENS settings are based on the gate control theory of pain. TENS is agree to produce a significant reduction in pain. Transcutaneous electrical nerve stimulation (TENS) is an inexpensive, noninvasive, self-administered technique that is use as an adjunct to medication. TENS treatment is rarely associated with negative side effects and has been reported to be effective in patients with neuropathic pain. Most studies evaluated the effect of high-frequency or low-frequency TENS (LF-TENS).The study aim is to investigate the effect of LF-TENS on the treatment of neuropathic pain in patients with post-stroke shoulder pain.

Therapeutic Ultrasound a physical therapy agent commonly used to increase temperature in deep tissue. The biologic effects observed when mammalian tissues are expose to ultrasound include changes in blood flow rates, tissue metabolism, the extensibility of connective tissue, and tissue regeneration. Thermal effects of therapeutic ultrasound reduces pain, swelling and improve ROM. When treating knee, shoulder, and hip pain, therapeutic ultrasound is routinely utilize in conjunction with other physiotherapeutic methods. The body of research on knee arthritis is very strong, and there is some evidence that therapeutic ultrasound is effective although there is debate about whether ultrasound should be delivered continuously or in pulses. Although ultrasound therapy alone may not have much of an effect on functional improvement, it can be a fair adjunct to take into account when combined with other widely used modalities.

The current study aims to evaluate and generalize the comparative effects of low frequency transcutaneous electrical stimulation combined with therapeutic ultrasound and therapeutic ultrasound and low frequency TENS alone in our settings. It is suggested that low frequency TENS with therapeutic ultrasound would provide a clinically and statistically significant benefit over a therapeutic ultrasound and low frequency TENS alone for patients with functional disability in post stroke shoulder pain. The purpose of the study is to determine an appropriate and cost-effective rehabilitation protocol for patients with functional disability in post-stroke shoulder pain.

Literature review.

A randomize clinical trial conducted in 2010 to evaluate the effect of therapeutic modalities on patients with post stroke shoulder pain. 45 patients were selected randomly with post stroke shoulder pain. Patients were randomly assigned into group A and group B .Group A patients treated by TENS, NASIAD, Exercise and ADLs instructions and group B received therapeutic ultrasound, NSAID, Exercise and ADLs instructions for 5 visits after every two weeks interval. The study recommended that TENS is more effective than therapeutic ultrasound.

A single blind, randomized controlled trial was conducted in 2017 determine the effect of EMG-triggered neuromuscular electrical stimulation with bilateral arm training on hemiplegic shoulder pain and arm function after stroke. Thirty-eight patients with post-stroke shoulder pain were randomized to EMG-triggered NMES or TENS. Both groups received electrical stimulation followed by bilateral arm training 3 times a week for 4 weeks. Primary outcome measures included a vertical numerical rating scale supplemented by a face rating scale and the short form of the Brief Pain Inventory. Secondary outcome measures were the upper extremity subscale of the Fugl-Meyer rating and pain-free passive shoulder range of motion. All outcomes were measured before treatment, post treatment. Two-way mixed repeated- measures ANOVAs were used to examine treatment effects. EMG-triggered NMES with bilateral arm training showed greater immediate and sustained effects than TENS with bilateral arm training on shoulder pain and damage in chronic and subacute stroke patients with hemiplegic shoulder pain.

A research was conducted to evaluate the effectiveness of high-intensity laser therapy in the treatment of post-stroke patients with hemiplegic shoulder pain. A study was designed as a prospective, randomize clinical trial. Forty-four patients with hemiplegic shoulder pain accompanied by partial thickness rotator cuff tear were randomly divided into high intensity lesser therapy and control groups. High intensity lesser therapy group and control group treated with multidisciplinary rehabilitation and therapeutic exercise program in addition to this three session of intervention per week for three weeks received by high intensity lesser therapy group. High intensity lesser therapy treatment significantly decrease pain ,increase range of motion and functional independence as compare to control group.

Study Type

Interventional

Enrollment (Estimated)

48

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Pakistan
    • Punjab
      • Bahawalpur, Punjab, Pakistan, 63100
        • Recruiting
        • Bahawal Victoria Hospital
        • Contact:
          • Muhammad Irshad
          • Phone Number: 03336352593
        • Principal Investigator:
          • toqeer zulfiqar, DPT

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Age 65-84 years(23)

    • Both genders male and female will be included
    • Ischemic and hemorrhagic both types of strokes will be included
    • Patients with a history of shoulder pain

Exclusion Criteria:

  • Patients with another neurological disease

    • Patients with unstable cardiovascular disease such as ventricular arrhythmias
    • Patients with a history of traumatic brain injury Patients with a history of traumatic brain injury
    • Any contraindications for UST or TENS therapy

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Other
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Low frequency transcutaneous electrical stimulation and Therapeutic Ultrasound
participant will receive low frequency transcutaneous electrical stimulation and therapeutic Ultrasound as a treatment
Other: low frequency transcutaneous electrical stimulation and Therapeutic Ultrasound
patients will receive low-frequency transcutaneous electrical stimulation for 15 minutes and therapeutic Ultrasound for 10 minutes as a treatment and patients will receive a total of 12 treatment sessions (3 sessions per week for 4 weeks and then follow-up will be done for the next 2 weeks) and the total duration of each session will be of 25 minutes.
Active Comparator: Therapeutic Ultrasound
patients will receive therapeutic ultrasound as a treatment
Other: Therapeutic Ultrasound
patients will receive a therapeutic ultrasound for 10 minutes three times a week for 4 weeks and then follow-up will be done for the next 2 weeks
Active Comparator: Low frequency transcutaneous electrical stimulation
participant will receive low frequency transcutaneous electrical stimulation
Other: Low frequency transcutaneous electrical stimulation
participants will receive low-frequency transcutaneous electrical stimulation for 15 minutes three times a week for 4 weeks and then follow-up will be done for the next 2 weeks

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
.Numerical Pain Rating Scale
Time Frame: 6 weeks
We used an 11-point numerical pain rating scale. (Where 0 = no pain; 10 = maximum pain) to assess the intensity of spontaneous HSP. The patients were required not to take analgesics or muscle relaxants for 24 h prior to the assessment
6 weeks
Shoulder Pain and Disability Index
Time Frame: 6 weeks
shoulder pain and disability index is a 13 items subjective questionnaire. Which is used to measure the level of pain and disability associated with shoulder pathologies. It has two subsets: Pain (5 items) and disability (8 items) to assess functional status of individuals with shoulder problems
6 weeks
Disabilities of Arm, Shoulder Hand questionnaire
Time Frame: 6 weeks
The Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Measure is a 30-item, self- report questionnaire designed to measure physical function and symptoms in patients with any or several musculoskeletal disorders of the upper limb. The questionnaire was designed to help describe the disability experienced by people with upper-limb disorders and also to monitor changes in symptoms and function over time
6 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Riphah International University

Investigators

  • Principal Investigator: Hira Jabeen, Riphah International University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

November 11, 2022

Primary Completion (Estimated)

August 15, 2023

Study Completion (Estimated)

October 1, 2023

Study Registration Dates

First Submitted

June 26, 2023

First Submitted That Met QC Criteria

June 26, 2023

First Posted (Actual)

July 5, 2023

Study Record Updates

Last Update Posted (Actual)

July 14, 2023

Last Update Submitted That Met QC Criteria

July 12, 2023

Last Verified

July 1, 2023

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • REC/RCR & AHS/23/0201

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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