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 o f daily living (ADL) of stroke patients. Setting: A university hospita l. Patients: Patients who had had a stroke 30-240 days before entry to a university rehabilitation centre. Design: Controlled design with bl ock randomization and blinded assessment. Intervention: All patients h ad Todd-Davies exercises. In group 1 (n = 30) TENS with frequency of 1 00 Hz was used at an intensity that the patient could tolerate; in gro up 2 (n = 30) patients were given placebo TENS. The treatment protocol consisted of 40 sessions (eight weeks). Outcomes: The Barthel Index f or daily living activities was used to measure functional changes over time, and the Ashworth Scale was used to measure spasticity in the el bow, knee and ankle. These measurements were made prior to and followi ng the treatment by assessors unaware of the patient's group allocatio n. 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 feedi ng, transfer, hygiene, toileting, bathing, walking, climbing stairs, d ressing, 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 g roups but the difference in the change score between the two groups wa s statistically significant (p<0.001). Spasticity was reduced in the a ctive treatment group. Conclusion: TENS appears to be an effective adj unct in the regaining of motor functions and improving ADL in hemipleg ic patients, but the accidental imbalance in severity of disability at entry makes interpretation uncertain.