Significancia clínica de la estimulación nerviosa transcutánea (TENS) en el dolor lumbar crónico
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Archivos
Fecha
2022
Profesor/a Guía
Facultad/escuela
Idioma
es
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ISSN de la revista
Título del volumen
Editor
Universidad Andrés Bello
Nombre de Curso
Licencia CC
Licencia CC
Resumen
Objetivo: Determinar la relevancia clínica del TENS en el manejo de dolor
lumbar en variables como la intensidad de dolor, umbral de dolor por presión
o funcionalidad.
Materiales y métodos: En esta revisión se realizó una búsqueda
computarizada, de estudios clínicos aleatorizados en las bases de datos
bibliográficas Web of Science, PEDro, Pubmed. Se analizaron títulos y
resúmenes de las publicaciones encontradas entre los años 1990 hasta 2022
y se analizaron a partir de los criterios de inclusión y exclusión establecidos.
El proceso se complementó con una búsqueda manual que incluye la revisión
de las listas de referencia de los artículos seleccionados, revisiones de
literatura previas en el área y literatura gris. Los artículos finalmente
seleccionados fueron evaluados metodológicamente a través de la escala
PEDro.
Resultados: Se incluyeron 7 artículos todos ellos ensayos aleatorizados que
contaban con indicadores de significancia clínica, equivalente a un 21%.
Dentro de las características de los estudios es importante destacar que en 4
de ellos no se especifica la diferenciación por sexo. Las variables más
analizadas antes y después de la aplicación del TENS fueron la intensidad de
dolor y la capacidad funcional o limitaciones de la vida diaria. Otras medidas
de resultado en los estudios incluyeron balance dinámico y estabilidad
estática. Los 7 presentaron variaciones en el dolor; Ebadi et al. 2018
destacan un cambio significativo en la escala VAS, donde tras 20 minutos de
tratamiento, esta disminuyó significativamente más en el grupo de TENS. Se
demostró que el efecto de interacción fue significativo desde el inicio hasta
después de 20 min desde el cese del tratamiento (F(1,28) = 51,05, p <
0,000), y desde la terminación del tratamiento hasta 20 min (F (1,28) = 86.76,
p < 0.000), lo que indica que la VAS disminuyó significativamente mayor en el
grupo TENS en estos 2 tiempos Intervalos. Conclusiones: En base a la limitada evidencia disponible que reportan
relevancia clínica de los cambios obtenidos posterior a la aplicación del TENS
no es posible confirmar los efectos en el dolor lumbar crónico. Son necesario
mayor números de estudios aleatorizados con protocolo más consistentes y
replicables en donde los investigadores deberían poner mayor énfasis en el
reporte de la magnitud de los cambios obtenidos como resultado del TENS y
no quedarse con el reporte dicotómico (significativo vs no significativo) de la
significancia estadística a través del valor de p. para poder concluir
definitivamente sobre el aporte clínico del TENS en el dolor lumbar crónico.
Objective: To determine the clinical relevance of TENS in the management of low back pain in variables such as pain intensity, pressure pain threshold or functionality. Materials and methods: In this review, a computerized search of randomized clinical studies was carried out in the bibliographic databases Web of Science, PEDro, Pubmed. Titles and abstracts of publications found between the years 1990 and 2022 were analyzed and analyzed based on the established inclusion and exclusion criteria. The process was complemented by a manual search that included review of the reference lists of the selected articles, previous literature reviews in the area, and gray literature. The finally selected articles were methodologically evaluated through the PEDro scale. Results: 7 articles were included, all of them randomized trials that had indicators of clinical significance, equivalent to 21%. Among the characteristics of the studies, it is important to highlight that in 4 of them the differentiation by sex is not specified. The variables most analyzed before and after the application of TENS were the intensity of pain and the functional capacity or limitations of daily life. Other outcome measures in the studies included dynamic balance and static stability. All 7 presented variations in pain; Ebadi et al. 2018 highlight a significant change in the VAS scale, where after 20 minutes of treatment, it decreased significantly more in the TENS group. The interaction effect was shown to be significant from baseline to 20 min after cessation of treatment (F(1,28) = 51.05, p < 0.000), and from treatment termination to 20 min (F (1.28) = 86.76, p < 0.000), indicating that VAS decreased significantly more in the TENS group at these 2 time intervals. Conclusions: Based on the limited available evidence that reports clinical relevance of the changes obtained after the application of TENS, it is not possible to confirm the effects on chronic low back pain. Larger numbers of randomized studies with more consistent and replicable protocols are needed, where researchers should place greater emphasis on reporting the magnitude of the changes obtained as a result of TENS and not stay with the dichotomous report (significant vs. non-significant) of the statistical significance through the value of p. in order to definitively conclude on the clinical contribution of TENS in chronic low back pain.
Objective: To determine the clinical relevance of TENS in the management of low back pain in variables such as pain intensity, pressure pain threshold or functionality. Materials and methods: In this review, a computerized search of randomized clinical studies was carried out in the bibliographic databases Web of Science, PEDro, Pubmed. Titles and abstracts of publications found between the years 1990 and 2022 were analyzed and analyzed based on the established inclusion and exclusion criteria. The process was complemented by a manual search that included review of the reference lists of the selected articles, previous literature reviews in the area, and gray literature. The finally selected articles were methodologically evaluated through the PEDro scale. Results: 7 articles were included, all of them randomized trials that had indicators of clinical significance, equivalent to 21%. Among the characteristics of the studies, it is important to highlight that in 4 of them the differentiation by sex is not specified. The variables most analyzed before and after the application of TENS were the intensity of pain and the functional capacity or limitations of daily life. Other outcome measures in the studies included dynamic balance and static stability. All 7 presented variations in pain; Ebadi et al. 2018 highlight a significant change in the VAS scale, where after 20 minutes of treatment, it decreased significantly more in the TENS group. The interaction effect was shown to be significant from baseline to 20 min after cessation of treatment (F(1,28) = 51.05, p < 0.000), and from treatment termination to 20 min (F (1.28) = 86.76, p < 0.000), indicating that VAS decreased significantly more in the TENS group at these 2 time intervals. Conclusions: Based on the limited available evidence that reports clinical relevance of the changes obtained after the application of TENS, it is not possible to confirm the effects on chronic low back pain. Larger numbers of randomized studies with more consistent and replicable protocols are needed, where researchers should place greater emphasis on reporting the magnitude of the changes obtained as a result of TENS and not stay with the dichotomous report (significant vs. non-significant) of the statistical significance through the value of p. in order to definitively conclude on the clinical contribution of TENS in chronic low back pain.
Notas
Proceso investigativo (Licenciado en Kinesiología)
Palabras clave
Dolor de la Región Lumbar, Estimulación Nerviosa Transcutánea