Journal of Rehabilitation Medicine 51-4inkOmslag | Page 84

318 Letter to the Editor TENS Study or Subgroup Mean Mean Difference SD Total Weight 2.5 0.6 22 2.95 0.69 20 55.6% -0.45 [-0.84, -0.06] Park 2014 1.8 0.41 15 2.36 0.74 14 44.4% -0.56 [-1.00, -0.12] 37 Mean Difference IV, Fixed, 95% CI 34 100.0% -0.50 [-0.79, -0.21] Heterogeneity: Chi = 0.13, df = 1 (P = 0.71); I = 0% Test for overall effect: Z = 3.34 (P = 0.0008) -2 -1 0 1 Favours [experimental] Favours [control] 2 Analysis 3. Comparison of transcutaneous electrical nerve stimulatin vs control group: effect on lower limb spasticity post intervention. The results show that there is no basis to claim that TENS treatment is superior to physiotherapy training, or that TENS combined with additional physiotherapy is superior to placebo combined with physiotherapy. For meta-analysis of lower limb spasticity change, the authors have mistakenly included outcomes related to the upper extremity (6). Therefore, we updated this meta-analysis with appropriate results (Analysis 3). Finally, the authors stated that papers were searched according to the following key words: transcutaneous electrical nerve stimulation or TENS, and stroke or hemiplegic within PubMed, Embase, Web of Science, EBSCO, and the Cochrane Library. The authors identi- fied 923 articles. However, combining these key words (i.e. MeSH) on PubMed only we identified 79 RCTs. Thus, the annex of the search strategy would be very helpful for future reproduction of this meta-analysis. All the issues and findings presented in this review should be updated and stated clearly to clarify the information. The author have no conflicts of interest to declare. REFERENCES 1. Lin S, Sun Q, Wang H, Xie G. Influence of transcutaneous electrical nerve stimulation on spasticity, balance, and walking speed in stroke patients: a systematic review and meta-analysis. J Rehabil Med 2018; 50: 3–7. 2. Etoom M. Comments on: Influence of transcutaneous electrical nerve stimulation on spasticity, balance, and walking speed in stroke patients: a systematic review and meta-analysis. J Rehabil Med 2018; 50: 94. 3. Burridge JH, Taylor PN, Hagan SA, Wood DE, Swain ID. The effects of common peroneal stimulation on the effort and speed of walking: a randomized controlled trial with chro- nic hemiplegic patients. Clin Rehabil 1997; 11: 201–210. 4. Ng SS, Hui-Chan CW. Transcutaneous electrical nerve stimulation combined with task-related training improves lower limb functions in subjects with chronic stroke. Stroke 2007; 38: 2953–2959. 5. Park J, Seo D, Choi W, Lee S. The effects of exercise with TENS on spasticity, balance, and gait in patients with ch- ronic stroke: a randomized controlled trial. Med Sci Monit 2014; 20: 1890–1896. 6. Kim TH, In TS, Cho HY. Task-related training combined with transcutaneous electrical nerve stimulation promotes up- per limb functions in patients with chronic stroke. Tohoku J Exp Med 2013; 231: 93–100. 7. Cho HY, In TS, Cho KH, Song CH. A single trial of trans- cutaneous electrical nerve timulation (TENS) improves spasticity and balance in patients with chronic stroke. Tohoku J Exp Med 2013; 229: 187–193. 8. Yan T, Hui-Chan CW. Transcutaneous electrical stimula- tion on acupuncture points improves muscle function in subjects after acute stroke: a randomized controlled trial. J Rehabil Med 2009; 41: 312–316. 9. Chen SC, Chen YL, Chen CJ, Lai CH, Chiang WH, Chen WL. Effects of surface electrical stimulation on the muscle–ten- don junction of spastic gastrocnemius in stroke patients. Disabi Rehabil 2005; 27: 105–110. Accepted Feb 6, 2019; Epub ahead of print Feb 25, 2019 Pawel Kiper, PhD* and Andrea Turolla, PhD From the Laboratory of Neurorehabilitation Technologies, Fondazione Ospedale San Camillo IRCCS, Venice, Italy. *E-mail: [email protected] The authors of the original articles (Lin et al.) were given the opportunity to comment in response to this Letter, but chose not to do it. IV, Fixed, 95% CI Cho 2013 Total (95% CI) Control SD Total Mean www.medicaljournals.se/jrm