The effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) versus Interferential Current (IFC) in the treatment of pain following a distal radius fracture.

Abstract

Purpose : The radius bone in the forearm of the human body, is an integral component of the wrist joint. Optimal wrist joint function plays an important role in maintaining dexterity of the upper limb. The inability to use the upper limb due to injury or pathology, impacts on activities of daily living, like personal care, occupational needs, and social activities. Following the fracture of the distal radius, a period of immobilisation is required for the injured structures to heal. Physiotherapy after the period of immobilisation is aimed at improving mobility, strength and flexibility of the affected joint. At this stage, patient’s main complaints are pain and stiffness which is impeding on functional use of the affected limb. Analgesia is usually prescribed to the patient for pain management, however in the South African public sector, drug shortages is a problem. Therefore there is a need to investigate a rehabilitation intervention that may reduce pain and hasten functional recovery after a distal radius fracture (DRF). Transcutaneous Electrical Nerve Stimulation (TENS) and Interferential Current (IFC) are two electrotherapy modalities, commonly used in the management of pain. Their effectiveness in reducing pain following a distal radius fracture has not been established. Therefore this study was designed to determine the effectiveness of TENS and IFC in reducing pain experienced following a distal radius fracture. Methods: The design of the study was a pre-test, post-test between subject study. Fifty four patients were randomly assigned to a TENS and exercise or IFC and exercise group. Both groups engaged in a 2-3 week programme, which comprised of six sessions of intervention. Pain was recorded with the Verbal Numerical Rating Scale (VNRS). Range of movement was measured with a goniometer and muscle strength with a modified sphygmomanometer. Functional ability was assessed with activities from the Patient Rated Wrist Evaluation (PRWE). Results : Statistical analysis was done with IBM SPSS (Version 21.0, IBM Corp., Armonk, NY). There was no significant differences between groups at the baseline with post 2-3 weeks showing compliance with TENS and exercises of 37% (n=20), IFC and exercises 37% (n=20). There were significant improvements (p < 0,05) in pain, range of movement, grip strength, and functional ability with both interventions. IFC was found to be significantly more effective in increasing wrist flexion and extension range of movements. Conclusion : Tens and IFC are effective in reducing pain following a distal radius fracture. There was no significant difference between the two modalities in reducing pain. Other variables of range of movement, muscle strength and functional ability also improved.