Efficacy of Adjunctive Transcutaneous Electrical Nerve Stimulation in Patients with Spastic Cerebral Palsy: A Systematic Review and Meta-analysis.

Introduction: The efficacy and safety of transcutaneous electrical nerve stimulation (TENS) in patients with cerebral palsy (CP) have been investigated in only a few randomized-controlled trials (RCTs). However, to date, no systematic review has synthesised the findings from these studies.

Methods: To identify controlled clinical trials (randomized/non-randomized) investigating the effectiveness and safety of TENS in patients with spastic CP, relevant electronic databases were searched using appropriate MESH terms. The primary objectives of this review were to compare the changes in gross motor function, spasticity, hand function, gait parameters, health-related quality of life (HRQOL), self-reported pain, and treatment-emergent adverse events (TEAEs) between the TENS and control groups. The Mantel Haenszel method determined the pooled estimate with a random or fixed-effect model.

Results: The review included seven clinical trials, with a total of 154 participants in the TENS group and 138 participants in the control group. The TENS interventions varied, with current ranging from 3 to 50 mA (median-15 mA), stimulation frequency from 2 to 50 Hz (median-20 Hz), and pulse duration from 0.25 to 250 ms (median-200 ms). The treatments were generally administered daily for 1 to 8 weeks (median-6 weeks). The results showed that the TENS group exhibited greater improvements in gross motor function, gait velocity, hand function, spasticity of targeted muscle, handgrip strength, and HRQOL compared to the control group (p < 0.0001, 0.03, 0.02, < 0.0001, 0.03, and 0.01 respectively). The incidence of TEAEs was rare, mild, and self-resolving, and no significant difference was observed between the TENS and control groups (p = 0.72).

Conclusion: The findings suggest that TENS may offer some benefits in improving spasticity and motor function in patients with cerebral palsy. However, it is important to note that more high-quality RCTs are required before making a definitive conclusion.