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Randomized Controlled Trial
. 2017 Jun 30;12(6):e0180328.
doi: 10.1371/journal.pone.0180328. eCollection 2017.

Addition of transcranial direct current stimulation to quadriceps strengthening exercise in knee osteoarthritis: A pilot randomised controlled trial

Wei-Ju Chang  1 , Kim L Bennell  2 , Paul W Hodges  3 , Rana S Hinman  2 , Carolyn L Young  1 , Valentina Buscemi  1 , Matthew B Liston  1 , Siobhan M Schabrun  1
Affiliations
Randomized Controlled Trial

Addition of transcranial direct current stimulation to quadriceps strengthening exercise in knee osteoarthritis: A pilot randomised controlled trial

Wei-Ju Chang et al. PLoS One. .

Abstract

A randomised, assessor- and participant-blind, sham-controlled trial was conducted to assess the safety and feasibility of adding transcranial direct current stimulation (tDCS) to quadriceps strengthening exercise in knee osteoarthritis (OA), and provide data to inform a fully powered trial. Participants were randomised to receive active tDCS+exercise (AT+EX) or sham tDCS+exercise (ST+EX) twice weekly for 8 weeks whilst completing home exercises twice per week. Feasibility, safety, patient-perceived response, pain, function, pressure pain thresholds (PPTs) and conditioned pain modulation (CPM) were assessed before and after treatment. Fifty-seven people were screened for eligibility. Thirty (52%) entered randomisation and 25 (84%) completed the trial. One episode of headache in the AT+EX group was reported. Pain reduced in both groups following treatment (AT+EX: p<0.001, partial η2 = 0.55; ST+EX: p = 0.026, partial η2 = 0.18) but no between-group differences were observed (p = 0.18, partial η2 = 0.08). Function improved in the AT+EX (p = 0.01, partial η2 = 0.22), but not the ST+EX (p = 0.16, partial η2 = 0.08) group, between-group differences did not reach significance (p = 0.28, partial η2 = 0.052). AT+EX produced greater improvements in PPTs than ST+EX (p<0.05) (superolateral knee: partial η2 = 0.17; superior knee: partial η2 = 0.3; superomedial knee: partial η2 = 0.26). CPM only improved in the AT+EX group but no between-group difference was observed (p = 0.054, partial η2 = 0.158). This study provides the first feasibility and safety data for the addition of tDCS to quadriceps strengthening exercise in knee OA. Our data suggest AT+EX may improve pain, function and pain mechanisms beyond that of ST+EX, and provides support for progression to a fully powered randomised controlled trial.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Consort diagram for flow of participants through the trial.
Fig 2
Fig 2. Percentage of participants reporting perceived improvement across categories from ‘not changed’ to ‘much improved’.
Note: no participants reported that their condition worsened after either intervention.
Fig 3
Fig 3. Pain and WOMAC physical function subscale (mean and 95% confidence interval) pre- and post-interventions.
Active tDCS + exercise produced improvements in pain and function but sham tDCS + exercise only produced improvement in pain.
Fig 4
Fig 4. Group change in pain (left panel) and WOMAC physical function subscale (right panel).
The graph showed within-group changes (mean and 95% confidence interval) in pain and function following 8 weeks of either active tDCS + exercise or sham tDCS + exercise. Note: larger negative scores indicate greater improvements in pain and function. The dotted line indicates the minimal clinically important change for each outcome.
Fig 5
Fig 5. Pressure pain thresholds (mean and 95% confidence interval) pre- and post-interventions at three knee sites.
Active tDCS + exercise produced greater improvements in pressure pain thresholds at all three sites following 8 weeks of treatment compared with sham tDCS + exercise (A = superolateral knee; B = superior knee; C = superomedial knee).
See this image and copyright information in PMC

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