Efectos sobre la funcionalidad y dimensiones del dolor crónico de la adición de terapia directa transcraneal y TENS a un programa de educación y ejercicio en sujetos con dolor crónico por osteoartritis de rodilla

Zusammenfassung

Knee osteoarthritis shows a high worldwide prevalence. Subjects under this condition present with persistent pain and decreased physical performance. A systematic review and meta-analysis conducted as part of this doctoral thesis suggests that transcranial stimulation therapy may be a promising therapeutic approach to improve the physical function of patients with knee osteoarthritis, especially when combined with physical therapy or transcutaneous nerve stimulation. The objectives of this thesis were to determine, in patients with knee osteoarthritis, whether the addition of transcranial direct therapy and TENS to an education and exercise program improves the clinical conditions of knee osteoarthritis; additionally to identify the relationship between movement-evoked pain, self-reported pain at rest and functionality during mobility and physical activity tests in people with knee osteoarthritis and, finally, to explore the convergent validity of walking-based physical performance tests, such as the 2 Minute Walk test and the 10 Meter Walk test, as performance measures potentially representative of the distance covered in the 6 Minute Walk test for knee osteoarthritis. For these purposes, different methodologies were implemented: we carried out a three-arm single-blind randomized clinical trial in which transcranial therapy and TENS were applied to subjects who received an education and exercise program focused on knee osteoarthritis. The last two objectives were explored through a cross-sectional, observational and descriptive design in which correlations between the different constructs were examined, especially the association between the construct of self-reported pain at rest and pain evoked by movement. In addition, the correlation of the 2 Minute Walk and 10 Meter Walk tests with the 6 Minute Walk test was also explored. The results of the clinical trial carried out show the absence of significant differences with respect to pain, psychoemotional components of pain or physical function after adding transcranial stimulation therapy and/or transcutaneous nerve stimulation to a limb strengthening education and exercise program among patients with knee osteoarthritis. Strengthening and education programs provide positive effects with or without the addition of transcranial stimulation therapy and/or TENS in addressing pain and loss of physical function due to osteoarthritis. The evaluation of movement-evoked pain in patients with knee osteoarthritis demonstrates adequate discriminant validity, since it is not related to self-reported pain at rest or functional performance. Furthermore, movement-evoked pain is, on average, lower than self-reported pain at rest. It was also found that movement-evoked pain and self-reported pain at rest measure different constructs within the context of osteoarthritis. The 2 Minute Walk and 10 Meter Walk tests show adequate convergent validity with respect to the 6 Minute Walk test in patients with knee osteoarthritis. These tests can not only predict the results of the 6 Minute Walk test, but they are also less burdensome and better in terms of time-based cost-efficiency.