Effect of transcutaneous electrical nerve stimulation (TENS) on Barthel Activities of Daily Living (ADL) Index score following stroke

Objective: To evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) and placebo TENS on the level of activities of daily living (ADL) of stroke patients. Setting: A university hospital. Patients: Patients who had had a stroke 30-240 days before entry to a university rehabilitation centre. Design: Controlled design with block randomization and blinded assessment. Intervention: All patients had Todd-Davies exercises. In group 1 (n = 30) TENS with frequency of 100 Hz was used at an intensity that the patient could tolerate; in group 2 (n = 30) patients were given placebo TENS. The treatment protocol consisted of 40 sessions (eight weeks). Outcomes: The Barthel Index for daily living activities was used to measure functional changes over time, and the Ashworth Scale was used to measure spasticity in the elbow, knee and ankle. These measurements were made prior to and following the treatment by assessors unaware of the patient's group allocation. Results: There were 30 patients in each group. Patients in group 1 (active TENS) were more disabled at entry to the study. Statistically significant improvements were recorded in all parameters such as feeding, transfer, hygiene, toileting, bathing, walking, climbing stairs, dressing, bowel and bladder care for group 2 (p<0.001) but only in some items in group 2. The change in total score was significant in both groups but the difference in the change score between the two groups was statistically significant (p<0.001). Spasticity was reduced in the active treatment group. Conclusion: TENS appears to be an effective adjunct in the regaining of motor functions and improving ADL in hemiplegic patients, but the accidental imbalance in severity of disability at entry makes interpretation uncertain.