{"title":"tDCS联合TENS在老年膝关节骨关节炎患者跨越障碍时缓解疼痛和改善步态模式的作用。","authors":"Xinmeng Zhang, Dongmei Wang, Qingqing Song, Xin Luo, Yubin Ge, Peixin Shen, Qipeng Song","doi":"10.3389/fspor.2025.1631357","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Older adults with knee osteoarthritis (KOA) exhibit an elevated risk of falls during obstacle negotiation, primarily due to pain-induced gait deviations. While transcutaneous electrical nerve stimulation (TENS) offers modest pain relief and limited gait modulation, combining it with transcranial direct current stimulation (tDCS) may enhance the effects. This study evaluated the comparative efficacy of tDCS + TENS vs. TENS alone in mitigating pain and optimizing gait patterns during obstacle crossing in older adults with KOA.</p><p><strong>Methods: </strong>Twenty-three participants with KOA (mean age: 67.6 ± 5.0 years; BMI: 25.9 ± 2.4 kg/m<sup>2</sup>) were randomized to either tDCS + TENS (<i>n</i> = 12; 7F/5M) or TENS-only (<i>n</i> = 11; 7F/4M) groups. Both interventions involved 20-minute sessions, administered thrice weekly for six weeks. Outcome measures included pain intensity (visual analog scale, VAS) and gait variables (foot clearance height, crossing velocity) assessed pre- (week 0) and post-intervention (week 7). Data were analyzed using mixed-design two-way ANOVAs with Bonferroni corrections.</p><p><strong>Results: </strong>Statistically significant group-by-time interactions were observed for pain (<i>p</i> = 0.002, <i>η</i> <sup>2</sup> <sub>p</sub> = 0.378), foot clearance (<i>p</i> = 0.038, <i>η</i> <sup>2</sup> <sub>p</sub> = 0.190), and crossing velocity (<i>p</i> < 0.001, <i>η</i> <sup>2</sup> <sub>p</sub> = 0.588). <i>post hoc</i> analyses revealed that the tDCS + TENS group (week0 = 4.72 ± 1.01, week7 = 1.98 ± 0.88, <i>p</i> < 0.001) experienced significantly greater reductions in pain scores compared to the TENS-only group (week0 = 5.02 ± 1.19, week7 = 3.56 ± 1.18, <i>p</i> < 0.001); tDCS + TENS group experienced significantly greater improvements in foot clearance (week0 = 0.19 ± 0.04, week7 = 0.20 ± 0.03, <i>p</i> < 0.001) and crossing velocity (week0 = 0.53 ± 0.11, week7 = 0.62 ± 0.08, <i>p</i> < 0.001), compared to the TENS-only group (week0 = 0.17 ± 0.02, week7 = 0.17 ± 0.02, <i>p</i> < 0.001; week0 = 0.52 ± 0.09, week7 = 0.54 ± 0.09).</p><p><strong>Conclusion: </strong>The combination of tDCS and TENS significantly outperformed TENS-only in reducing pain and enhancing gait adaptability during obstacle negotiation in older adults with KOA. These findings support the integration of tDCS as an adjunctive neuromodulatory strategy to amplify the therapeutic benefits of TENS in this population.</p>","PeriodicalId":12716,"journal":{"name":"Frontiers in Sports and Active Living","volume":"7 ","pages":"1631357"},"PeriodicalIF":2.6000,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12484165/pdf/","citationCount":"0","resultStr":"{\"title\":\"Effects of tDCS combined with TENS in relieving pain and improving gait patterns during stepping over obstacles among older adults with knee osteoarthritis.\",\"authors\":\"Xinmeng Zhang, Dongmei Wang, Qingqing Song, Xin Luo, Yubin Ge, Peixin Shen, Qipeng Song\",\"doi\":\"10.3389/fspor.2025.1631357\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Older adults with knee osteoarthritis (KOA) exhibit an elevated risk of falls during obstacle negotiation, primarily due to pain-induced gait deviations. While transcutaneous electrical nerve stimulation (TENS) offers modest pain relief and limited gait modulation, combining it with transcranial direct current stimulation (tDCS) may enhance the effects. This study evaluated the comparative efficacy of tDCS + TENS vs. TENS alone in mitigating pain and optimizing gait patterns during obstacle crossing in older adults with KOA.</p><p><strong>Methods: </strong>Twenty-three participants with KOA (mean age: 67.6 ± 5.0 years; BMI: 25.9 ± 2.4 kg/m<sup>2</sup>) were randomized to either tDCS + TENS (<i>n</i> = 12; 7F/5M) or TENS-only (<i>n</i> = 11; 7F/4M) groups. Both interventions involved 20-minute sessions, administered thrice weekly for six weeks. Outcome measures included pain intensity (visual analog scale, VAS) and gait variables (foot clearance height, crossing velocity) assessed pre- (week 0) and post-intervention (week 7). Data were analyzed using mixed-design two-way ANOVAs with Bonferroni corrections.</p><p><strong>Results: </strong>Statistically significant group-by-time interactions were observed for pain (<i>p</i> = 0.002, <i>η</i> <sup>2</sup> <sub>p</sub> = 0.378), foot clearance (<i>p</i> = 0.038, <i>η</i> <sup>2</sup> <sub>p</sub> = 0.190), and crossing velocity (<i>p</i> < 0.001, <i>η</i> <sup>2</sup> <sub>p</sub> = 0.588). <i>post hoc</i> analyses revealed that the tDCS + TENS group (week0 = 4.72 ± 1.01, week7 = 1.98 ± 0.88, <i>p</i> < 0.001) experienced significantly greater reductions in pain scores compared to the TENS-only group (week0 = 5.02 ± 1.19, week7 = 3.56 ± 1.18, <i>p</i> < 0.001); tDCS + TENS group experienced significantly greater improvements in foot clearance (week0 = 0.19 ± 0.04, week7 = 0.20 ± 0.03, <i>p</i> < 0.001) and crossing velocity (week0 = 0.53 ± 0.11, week7 = 0.62 ± 0.08, <i>p</i> < 0.001), compared to the TENS-only group (week0 = 0.17 ± 0.02, week7 = 0.17 ± 0.02, <i>p</i> < 0.001; week0 = 0.52 ± 0.09, week7 = 0.54 ± 0.09).</p><p><strong>Conclusion: </strong>The combination of tDCS and TENS significantly outperformed TENS-only in reducing pain and enhancing gait adaptability during obstacle negotiation in older adults with KOA. These findings support the integration of tDCS as an adjunctive neuromodulatory strategy to amplify the therapeutic benefits of TENS in this population.</p>\",\"PeriodicalId\":12716,\"journal\":{\"name\":\"Frontiers in Sports and Active Living\",\"volume\":\"7 \",\"pages\":\"1631357\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-09-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12484165/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Frontiers in Sports and Active Living\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.3389/fspor.2025.1631357\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"SPORT SCIENCES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Sports and Active Living","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3389/fspor.2025.1631357","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"SPORT SCIENCES","Score":null,"Total":0}
引用次数: 0
摘要
目的：患有膝骨关节炎（KOA）的老年人在过障时摔倒的风险增加，主要是由于疼痛引起的步态偏差。虽然经皮神经电刺激（TENS）可以适度缓解疼痛和有限的步态调节，但将其与经颅直流电刺激（tDCS）相结合可能会增强效果。本研究评估了tDCS + TENS与单独TENS在减轻老年KOA患者过障时疼痛和优化步态模式方面的比较疗效。方法：23例KOA患者（平均年龄：67.6±5.0岁，BMI: 25.9±2.4 kg/m2）随机分为tDCS + TENS组（n = 12; 7F/5M）和仅TENS组（n = 11; 7F/4M）。两种干预措施都是每次20分钟，每周进行三次，持续六周。结果测量包括疼痛强度（视觉模拟量表，VAS）和步态变量（足间隙高度，穿越速度）在干预前（第0周）和干预后（第7周）评估。数据分析采用Bonferroni校正的混合设计双向方差分析。结果：疼痛（p = 0.002, η 2 p = 0.378）、足部间隙（p = 0.038, η 2 p = 0.190）和穿越速度（p η 2 p = 0.588）组间交互作用有统计学意义。事后分析显示，tDCS + TENS组(第0周= 4.72±1.01，第7周= 1.98±0.88，p p p p p p p结论：tDCS + TENS在减轻老年KOA患者的疼痛和增强步态适应性方面明显优于单纯TENS。这些发现支持tDCS作为一种辅助神经调节策略的整合，以扩大TENS在该人群中的治疗效果。
Effects of tDCS combined with TENS in relieving pain and improving gait patterns during stepping over obstacles among older adults with knee osteoarthritis.
Purpose: Older adults with knee osteoarthritis (KOA) exhibit an elevated risk of falls during obstacle negotiation, primarily due to pain-induced gait deviations. While transcutaneous electrical nerve stimulation (TENS) offers modest pain relief and limited gait modulation, combining it with transcranial direct current stimulation (tDCS) may enhance the effects. This study evaluated the comparative efficacy of tDCS + TENS vs. TENS alone in mitigating pain and optimizing gait patterns during obstacle crossing in older adults with KOA.
Methods: Twenty-three participants with KOA (mean age: 67.6 ± 5.0 years; BMI: 25.9 ± 2.4 kg/m2) were randomized to either tDCS + TENS (n = 12; 7F/5M) or TENS-only (n = 11; 7F/4M) groups. Both interventions involved 20-minute sessions, administered thrice weekly for six weeks. Outcome measures included pain intensity (visual analog scale, VAS) and gait variables (foot clearance height, crossing velocity) assessed pre- (week 0) and post-intervention (week 7). Data were analyzed using mixed-design two-way ANOVAs with Bonferroni corrections.
Results: Statistically significant group-by-time interactions were observed for pain (p = 0.002, η2p = 0.378), foot clearance (p = 0.038, η2p = 0.190), and crossing velocity (p < 0.001, η2p = 0.588). post hoc analyses revealed that the tDCS + TENS group (week0 = 4.72 ± 1.01, week7 = 1.98 ± 0.88, p < 0.001) experienced significantly greater reductions in pain scores compared to the TENS-only group (week0 = 5.02 ± 1.19, week7 = 3.56 ± 1.18, p < 0.001); tDCS + TENS group experienced significantly greater improvements in foot clearance (week0 = 0.19 ± 0.04, week7 = 0.20 ± 0.03, p < 0.001) and crossing velocity (week0 = 0.53 ± 0.11, week7 = 0.62 ± 0.08, p < 0.001), compared to the TENS-only group (week0 = 0.17 ± 0.02, week7 = 0.17 ± 0.02, p < 0.001; week0 = 0.52 ± 0.09, week7 = 0.54 ± 0.09).
Conclusion: The combination of tDCS and TENS significantly outperformed TENS-only in reducing pain and enhancing gait adaptability during obstacle negotiation in older adults with KOA. These findings support the integration of tDCS as an adjunctive neuromodulatory strategy to amplify the therapeutic benefits of TENS in this population.
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