Estimulação elétrica neuromuscular (EENM) para síndrome da dor patelofemoral: revisão sistemática Cochrane

• Ano de defesa: 2016
• Autor(a) principal: Martimbianco, Ana Luiza Cabrera [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Patellofemoral pain syndrome; Patellofemoral joint; Electrical stimulation; Meta-analysis; Síndrome da dor patelofemora; Articulação patelofemoral; Estimulação elétrica; metanálise
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=4432756; http://repositorio.unifesp.br/handle/11600/47517

Purpose: To assess the effects (benefits and harms) of neuromuscular electrical stimulation (NMES) for patients with patellofemoral pain syndrome (PFPS). Methods: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PEDro, CINAHL, SPORTDiscus, AMED and LILACS. The search was carried out in May 2016. We included randomised controlled clinical trials. The primary outcomes were knee pain, knee function and adverse events. We calculated risk ratios (RR) for dichotomous data, mean differences (MD) or standard mean difference (SMD) for continuous data. Results: Eight randomised clinical trials were included, involving a total of 345, mostly female (52.5%), participants, with ages from 23 to 46 years. The participants' inclusion criteria varied, such as minimum duration of symptoms ranging from one to six months. Studies differed widely in the characteristics of NMES stimulation and associated co-interventions. All studies except one were categorised as having a high risk of bias in at least one criterion, especially blinding and incomplete outcome data. The overall quality of evidence for all primary outcomes, assessed through the GRADE approach, was considered 'very low'. We performed the following comparisons: NMES versus placebo (one study), NMES plus other intervention (e.g. exercise) versus no NMES plus same other intervention (four studies), NMES versus exercises (one study) and NMES with programmes of different frequencies of sessions (two studies). When compared to placebo, a single NMES session was associated with higher improvement in knee pain during single leg squat (MD -1.90, 95% CI -3.10 to -0.70; participants = 22; study = 1; P value = 0.002) and lateral step down (MD -2.20, 95% CI -3.47 to -0.93; participants = 22; study = 1; P value = 0.0007). When compared to another intervention alone, NMES plus the same other intervention was associated with: (a) higher improvement in overall knee pain at the end of the treatment (ranging from 3 to 6 weeks) (MD -1.70, 95% CI -2.33 to -1.08; participants = 82; studies = 2; P = 0.28; I2 = 13%); but not after 12 weeks of treatment (P = 0.64) and 1-year follow up; (b) lower improvement in knee pain during step-down (MD 3.32, 95% CI 2.38 to 4.26; participants = 30; study = 1; P < 0.00001) and step-up (MD 3.15, 95% CI 2.10 to 4.20; participants = 30; study = 1; P < 0.00001), after 6 weeks of treatment, and no statistically significant difference in knee pain during squatting movement (MD 0.58, 95% CI -0.91 to 2.07; participants = 30; study = 1; P = 0.44), after 6 weeks of treatment; (c) no statistically significant difference in change score for pain at 12 weeks of treatment (MD -0.55, 95% CI -2.81 to 1.71; participants = 36; study = 1; P = 0.63) and 1-year follow up; (d) no statistically significant difference in knee function at the end of the treatment (ranging from 3 to 6 weeks) (SMD 0.37, 95% CI -0.11 to 0.84; participants = 70; studies = 2; P = 0.30; I2 = 7%), nor at 12 weeks (P = 0.29) and 1-year follow up; (e) higher improvement in muscle strength for 30° knee flexion (MD 38.30, 95% CI 13.71 to 62.89; participants = 36; study = 1; P = 0.002) and 60° knee flexion (MD 50.00, 95% CI 11.30 to 88.70; participants = 36; study = 1; P = 0.01) after 12 weeks of treatment; but not at 6 weeks (RR 0.99, 95% CI 0.81 to 1.21; participants = 42; study = 1; P = 0.92). For the comparison NMES versus exercises, there was no statistically significant difference in knee function (MD -0.94, 95% CI -2.10 to 0.22; participants = 94; study = 1; P = 0.11) and muscle strength using an isokinetic dynamometer at speeds of 30°/s (MD 0.06, 95% CI -29.67 to 29.79; participants = 94; study = 1; P = 1.00) and 300°/s (MD 1.04, 95% CI -14.00 to 16.08; participants = 94; study = 1; P = 0.89), after 4 weeks of treatment. Conclusion: Although NMES is widely used, this review found insufficient evidence from randomised trials to support its use in patients with PFPS. Very low quality evidence indicates that: (a) a single session of NMES seems to be better than placebo for knee pain during activities; there is a probability that this benefit is not clinically relevant; (b) NMES plus another intervention seems to be better than another intervention alone for knee pain and muscle strength; there is uncertainty if this difference is clinically relevant; (c) NMES plus another intervention seems to be worse than the same other interventions alone for pain during activities, and this difference seems to be clinically relevant. Some aspects remain unclear, such as adverse events, quality of life, and patient satisfaction. More high-quality randomised clinical trials are still needed to recommend or not the use of NMES for patients with PFPS.