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Elboim Gabyzon M1, Andrawus Najjar S1,2, Haim Shtarker HS3,4
1University of Haifa, Physical Therapy, Haifa, Israel, 2Galilee Medical Center, Physical Therapy Department, Nahariya, Israel, 3Galilee Medical Center, Head of Department of Orthopedics, Nahariya, Israel, 4Bar Ilan University, Faculty of Medicine, Zefat, Israel
Background: Undertreated acute postoperative pain, following hip fracture, is related to negative consequences such as longer hospitalization time, restricted and delayed ambulation, reduced compliance with physical therapy, and higher immediate postoperative complication.
Transcutaneous electrical nerve stimulation (TENS) was shown to be an effective modality that may reduce acute postoperative pain and opioid consumption. While it has been shown in a single study that TENS enhances pain control following hip fracture surgery, there is no evidence as to the effect of TENS on functional performance outcomes after intramedullary nail fixation of hip fractures.
Purpose: To determine whether incorporating TENS treatment during standard rehabilitation care during the acute post-operative phase following Gamma nail surgical fixation of hip fracture has a beneficial effect on pain intensity and mobility.
Methods: Forty-one participants (average age 79.3-years and standard deviation 9.2 years were included in this double blind, randomized trial. Standard therapy treatment was applied to all participants which consisted of 30 minutes daily physical therapy treatments during five days of hospitalization, beginning 24 hours after surgery. Participants were randomized into one of two groups receiving either sham TENS or active TENS applied for 30 minutes.
Outcome measures included pain levels at rest, at night and during ambulation, measured by Numeric Rating Scale and ambulation status on days 1-5, measured with Functional Ambulation Classification (FAC) instrument. In addition, two physical performance tests (five times sit to stand and two-minute walk test) were conducted on the fifth day. Data were analyzed with Wilcoxon score rank (Rank sums) and signed rank tests. Significance was set at p≤0.05.
Results: Supplementing active TENS to the standard care following Gamma nail surgical fixation of hip fracture yielded significantly better results as compared to sham TENS treatment in terms of pain intensity while walking in the early postoperative period (pain reduction between the fifth day second days: 2.55±1.37 vs. 1.06± 1.11 respectively; p=0.0011). No additional effect of active TENS on pain at rest and at night was noted.
Level of ambulation improved significantly in both groups. However, greater improvement was seen in the active TENS group as compared to sham TENS. Active TENS resulted in greater increase in walking distance compared to the sham TENS
group. No effect was demonstrated on five times sit to stand test performance.
Conclusion(s): Adding TENS to the standard care of elderly patients following Gamma nail surgical fixation of hip fracture yielded significantly better results as compared to the standard care in terms of pain intensity while walking and mobility in the early postoperative period.
The long term effects of TENS on functional recovery and pain should be explored in future studies
Implications: The addition of TENS to the standard care of elderly patients in the early days following Gamma nail surgical fixation of extracapsular hip fracture is recommended for pain control and functional gait recovery.
Keywords: Transcutaneous electrical nerve stimulation, Hip fracture, acute postoperative pain intensity
Funding acknowledgements: The study was not supported by a research grant or other finding.
Transcutaneous electrical nerve stimulation (TENS) was shown to be an effective modality that may reduce acute postoperative pain and opioid consumption. While it has been shown in a single study that TENS enhances pain control following hip fracture surgery, there is no evidence as to the effect of TENS on functional performance outcomes after intramedullary nail fixation of hip fractures.
Purpose: To determine whether incorporating TENS treatment during standard rehabilitation care during the acute post-operative phase following Gamma nail surgical fixation of hip fracture has a beneficial effect on pain intensity and mobility.
Methods: Forty-one participants (average age 79.3-years and standard deviation 9.2 years were included in this double blind, randomized trial. Standard therapy treatment was applied to all participants which consisted of 30 minutes daily physical therapy treatments during five days of hospitalization, beginning 24 hours after surgery. Participants were randomized into one of two groups receiving either sham TENS or active TENS applied for 30 minutes.
Outcome measures included pain levels at rest, at night and during ambulation, measured by Numeric Rating Scale and ambulation status on days 1-5, measured with Functional Ambulation Classification (FAC) instrument. In addition, two physical performance tests (five times sit to stand and two-minute walk test) were conducted on the fifth day. Data were analyzed with Wilcoxon score rank (Rank sums) and signed rank tests. Significance was set at p≤0.05.
Results: Supplementing active TENS to the standard care following Gamma nail surgical fixation of hip fracture yielded significantly better results as compared to sham TENS treatment in terms of pain intensity while walking in the early postoperative period (pain reduction between the fifth day second days: 2.55±1.37 vs. 1.06± 1.11 respectively; p=0.0011). No additional effect of active TENS on pain at rest and at night was noted.
Level of ambulation improved significantly in both groups. However, greater improvement was seen in the active TENS group as compared to sham TENS. Active TENS resulted in greater increase in walking distance compared to the sham TENS
group. No effect was demonstrated on five times sit to stand test performance.
Conclusion(s): Adding TENS to the standard care of elderly patients following Gamma nail surgical fixation of hip fracture yielded significantly better results as compared to the standard care in terms of pain intensity while walking and mobility in the early postoperative period.
The long term effects of TENS on functional recovery and pain should be explored in future studies
Implications: The addition of TENS to the standard care of elderly patients in the early days following Gamma nail surgical fixation of extracapsular hip fracture is recommended for pain control and functional gait recovery.
Keywords: Transcutaneous electrical nerve stimulation, Hip fracture, acute postoperative pain intensity
Funding acknowledgements: The study was not supported by a research grant or other finding.
Topic: Orthopaedics; Orthopaedics; Older people
Ethics approval required: Yes
Institution: Galilee Medical Center, Israel
Ethics committee: Helsinki Committee
Ethics number: number 0110-14-NHR
All authors, affiliations and abstracts have been published as submitted.
