Effect of Combined Neuromuscular Electrical Stimulation and Disease-Modifying Antirheumatic Drug Therapy Versus Disease-Modifying Antirheumatic Drug Therapy Alone on Enhancing Gait and Reducing Fall Risks in Patients with Rheumatoid Arthritis and Peripheral Neuropathy
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Abstract
Background: Rheumatoid Arthritis (RA) with Peripheral Neuropathy (PN) significantly impacts gait and balance, posing challenges in patient management. While Disease-Modifying Antirheumatic Drug (DMARD) therapy is effective for RA, it may not fully address these functional impairments. Neuromuscular Electrical Stimulation (NMES) has been proposed as a complementary therapy to improve these outcomes.
Objective: This study aimed to assess the effectiveness of combining NMES with DMARD therapy versus DMARD therapy alone in enhancing gait and reducing fall risks among RA patients with PN.
Methods: In a randomized controlled trial, 66 RA patients with PN were allocated to either Group A (NMES + DMARD, n=33) or Group B (DMARD only, n=33). Baseline demographics (age, gender, BMI, RA duration) and clinical outcomes (stride length, gait speed, cadence, etc.) were measured. Assessments were conducted at the study’s onset and after an 8-week intervention period, with data analyzed using independent t-tests.
Results: Baseline data revealed no significant differences between the groups. Post-intervention, Group A exhibited marked improvements: stride length reduced to 58.26 cm (± 5.0) compared to Group B’s 69.1 cm (± 5.2, p=0.036), gait speed decreased to 0.77 m/s (± 5.1) against Group B’s 0.94 m/s (± 5.2, p=0.020), and cadence lowered to 81.43 steps/min (± 4.5) versus Group B’s 97.06 steps/min (± 4.7, p=0.029). Significant improvements were also seen in step width, double support time, and balance scales in Group A. However, biochemical markers did not show significant differences post-intervention.
Conclusion: The integration of NMES with DMARD therapy resulted in significant improvements in gait and balance parameters compared to DMARD therapy alone in RA patients with PN. These findings suggest that NMES could be an effective adjunct to DMARDs in managing functional impairments in this population.
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References
Viudes‐Sarrión N, Aleixandre‐Carrera F, Beltrá P, Ortega FJ, Molina‐Payá FJ, Velasco E, et al. Blood flow effects of percutaneous peripheral nerve stimulation. A blinded, randomized clinical trial. European Journal of Clinical Investigation. 2023:e14091.
Yeşilöz Ö, Aksoy MK. The effectiveness of peroneal nerve stimulation combined with neuromuscular electrical stimulation in the management of knee osteoarthritis: A randomized controlled single-blind study. Turkish Journal of Physical Medicine and Rehabilitation. 2023;69(3):317.
Jandova T, Narici MV, Steffl M, Bondi D, D’Amico M, Pavlu D, et al. Muscle hypertrophy and architectural changes in response to eight-week neuromuscular electrical stimulation training in healthy older people. Life. 2020;10(9):184.
Missé RG, Dos Santos LDM, Tanaka C, Baptista AF, Shinjo SK. Transcranial Direct Current Stimulation Combined with Peripheral Neuromuscular Stimulation Improves Quality of Life, Fatigue, and Pain in a Patient with Rheumatoid Arthritis and Refractory Radicular Pain Related to Spinal Stenosis. Open Journal of Rheumatology and Autoimmune Diseases. 2023;13(1):1-7.
De Souza JM, Trevisan TJ, Sepresse SR, Londe AC, França Júnior MC, Appenzeller S. Peripheral Neuropathy in Systemic Autoimmune Rheumatic Diseases—Diagnosis and Treatment. Pharmaceuticals. 2023;16(4):587.
Sanchis-Gomar F, Lopez-Lopez S, Romero-Morales C, Maffulli N, Lippi G, Pareja-Galeano H. Neuromuscular electrical stimulation: a new therapeutic option for chronic diseases based on contraction-induced myokine secretion. Frontiers in physiology. 2019;10:1463.
Blaise S, Sinniger V, Seinturier C. Literature review of transcutaneous electrical nerve stimulation in peripheral arterial occlusive disease of the lower limbs. JMV-Journal de Médecine Vasculaire. 2023.
Burgess L. Neuromuscular electrical stimulation to improve muscle weakness in hip osteoarthritis: A feasibility study: Bournemouth University; 2023.
Melo MdO, Pompeo KD, Baroni BM, Sonda FC, Vaz MA. Randomised study of the effects of neuromuscular electrical stimulation and low-level laser therapy on muscle activation and pain in patients with knee osteoarthritis. International Journal of Therapy And Rehabilitation. 2019;26(7):1-13.
Merheb D, Dib G, Zerdan MB, Nakib CE, Alame S, Assi HI. Drug-induced peripheral neuropathy: diagnosis and management. Current Cancer Drug Targets. 2022;22(1):49-76.
Pereira FdA, Lourenço MdA, Assis MRd. Evaluation of peripheral neuropathy in lower limbs of patients with rheumatoid arthritis and its relation to fall risk. Advances in Rheumatology. 2022;62:9.
Mrkvicová MV, Tilrem J. REHABILITATION IN PATIENTS AFTER TOTAL KNEE ARTHROPLASTY.
SINGH R, SRIPADMA P, MATHUR V, GANGULY S. A Cross-sectional Study on Electrophysiological Evaluation of Neuropathy in Rheumatoid Arthritis. Journal of Clinical & Diagnostic Research. 2021;15(4).
Takeda MM. The Effect of Neuromuscular Electrical Stimulation and Exercise on Clients with Nonspecific Chronic Low Back Pain: A Single Case Design: California State University, Fresno; 2021.
Peter WF, Swart NM, Meerhoff GA, Vliet Vlieland TP. Clinical practice guideline for physical therapist management of people with rheumatoid arthritis. Physical therapy. 2021;101(8):pzab127.
Mahran SA, Galluccio F, Khedr TM, Elsonbaty A, Allam AE-S, Martos AG, et al. Peripheral neuropathy in systemic lupus erythematosus: what can neuromuscular ultrasonography (NMUS) tell us? A cross-sectional study. Lupus Science & Medicine. 2021;8(1):e000521.
Jain KK, Jain KK. Drug-induced peripheral neuropathies. Drug-induced neurological disorders. 2021:437-67.
Gaino JZ, Bértolo MB, Nunes CS, Barbosa CdM, Landim SF, Sachetto Z, et al. The effect of foot orthoses on balance, foot function, and mobility in rheumatoid arthritis: A randomized controlled clinical trial. Clinical rehabilitation. 2021;35(7):1011-20.
Hsieh L-F, Mao H-F, Lu C-C, Hsu W-L. Rheumatologic rehabilitation. Braddom's Physical Medicine and Rehabilitation: Elsevier; 2021. p. 606-26. e1.
Burgess LC, Taylor P, Wainwright TW, Swain ID. Lab-based feasibility and acceptability of neuromuscular electrical stimulation in hip osteoarthritis rehabilitation. Journal of Rehabilitation and Assistive Technologies Engineering. 2021;8:2055668320980613.
Seca SMF. Effects of acupuncture on the pain and function of the hands of selected patients with rheumatoid arthritis: 00500:: Universidade de Coimbra; 2020.
Maeda M, Mutai H, Toya Y, Maekawa Y, Hitai T, Katai S. Effects of peripheral nerve stimulation on paralysed upper limb functional recovery in chronic stroke patients undergoing low-frequency repetitive transcranial magnetic stimulation and occupational therapy: A pilot study. Hong Kong Journal of Occupational Therapy. 2020;33(1):3-11.
Murphy D, Lester D, Clay Smither F, Balakhanlou E. Peripheral neuropathic pain. NeuroRehabilitation. 2020;47(3):265-83.