Effects of Transcutaneous Electrical Nerve Stimulation, Neuromuscular Electrical Stimulation, and Combination Therapy...

To compare the effectiveness of transcutaneous electrical nerve stimulation (TENS), neuromuscular electrical stimulation (NMES), and their combination in hemiplegic shoulder pain, upper-limb function, and joint range of motion (ROM) in patients with acute and subacute stroke.

Prospective randomized study.

Inpatient and outpatient rehabilitation settings.

Eighty patients were assessed for eligibility. Five patients were excluded before being randomly assigned. Seventy-five participants were randomly assigned, and 60 completed the study (TENS, n=21; TENS+NMES, n=20; and NMES, n=19).

All groups received a standardized rehabilitation program consisting of positioning, ROM exercises, stretching, strengthening, and task-oriented upper extremity training for 60 minutes per session, 5 days per week for 3 weeks. Group 1 received TENS, group 2 received combined TENS+NMES, and group 3 received NMES.

Primary outcome was pain intensity, assessed using the visual analog scale (VAS). Secondary outcomes included upper extremity motor function, assessed using the Fugl-Meyer Assessment for Upper Extremity; shoulder pain and disability, assessed using the Shoulder Pain and Disability Index (SPADI); spasticity, assessed using the Modified Ashworth Scale; activities of daily living (ADL) assessed using the Barthel Index (BI); and shoulder ROM, measured by goniometry.

All treatment groups showed significant improvements in VAS, Fugl-Meyer, SPADI, BI, and ROM scores after treatment. The TENS+NMES group demonstrated significantly greater reductions in pain and SPADI scores than the TENS group. However, post hoc analysis showed no significant difference between the TENS+NMES and NMES groups for SPADI.

Compared with TENS or NMES alone, the combined intervention improved pain, shoulder-related limitations, and shoulder ROM, but not upper extremity motor function, spasticity, or ADL. Combined electrical stimulation may be a useful adjunct for pain and shoulder function during early stroke rehabilitation, although larger studies are needed to confirm these findings.