A WEARABLE TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (W-TENS) DEVICE REDUCES THE NEED FOR SURGERY IN OVERWEIGHT PATIENTS WITH PAINFUL KNEE OSTEOARTHRITIS

Background: In Osteoarthritis (OA), all international recommendations suggest a combination of non-pharmacological treatments (physical activity, weight loss, etc.) and pharmacological treatments to be proposed according to OA phenotype and pain characteristics. Overweight (BMI ≥ 25) and obesity (BMI ≥ 30) are major OA risk factors [1] and obese patients are more likely to require total knee arthroplasty (TKA) [2]. With a global prevalence of obesity which has doubled in the last 40 years, it is important to delay surgery as much as possible. A new wearable transcutaneous electrical nerve stimulation (W-TENS) device, worn on the thigh, and connected to a smartphone, has been recently proposed for knee OA (KOA) pain management. It has demonstrated significant efficacy on pain and function and better tolerability versus weak opioids in a recent randomized controlled clinical trial [3]. Objectives: To investigate the impact of a connected W-TENS device on function, quality of life, surgery indication, and drugs intake in overweight patients with KOA in a cohort study, by comparing patients before and after 3 months of utilization. Methods: An online questionnaire was sent to 741 patients suffering from painful KOA and using the connected W-TENS device. The questionnaire was sent on the mobile application for one month (December 2023). Questions included demographic data, medical condition, current pain treatment, patient global impression of change (PGIC) on quality of life (QOL) and drug consumption, and Lequesne algo-functionnal questionnaire. PGIC was measured using a 7-point scale (-3 to 3). The Lequesne algofunctional index was used as a measure for knee surgery indication, as indicated by a score of 10 or more. Results: In a one-month study period, 91 patients answered to the questionnaire. We focused our analysis only on overweight patients, who represented 79% of the sample (72 patients including 59 patients who answered the Lequesne questionnaire). Among the overweight patients, 71% were female, 40% were under 65-year-old, 58% were retired and 54% were using the W-TENS device since less than 3 months. Most of patients were suffering from chronic pain: 78% were suffering from KOA for more than 1 year and 56% were suffering from additional pain (other than KOA). Management of painful KOA was multimodal: 33% were taking medication for KOA, 56% were practicing physical exercise or rehabilitation. Global impression of change in QOL and drug consumption respectively, were significantly improved both for patients using W-TENS less than 3 months (mean PGIC (SD, 95CI) =0.77 (1.01, [0.54;1.00]) and 0.90 (0.75, [0.74;1.08]) respectively) and for those using W-TENS more than 3 months (1.36 (0.86, [1.07;1.65]) and 1.73 (0.72, [1.48;1.98]) respectively). The improvement was more important in patients using W-TENS more than 3 months (p<0.01). Lequesne score was significantly lower for those using W-TENS more than 3 months (8.9 (3.3)) than for those using W-TENS less than 3 months (10.6 (3.5)), (p=0.04). Patients using the W-TENS for less than 3 months were therefore on average eligible for surgery (Lequesne score ≥10) whereas patients using W-TENS for more than 3 months were on average not eligible. Conclusion: Our cohort study on the effect of wearable and connected TENS in patients with painful KOA suggests a gain in mobility and a reduction surgery indication in overweight patients when used for more than 3 months, as well as an improvement in quality of life and reduction in drug consumption. It therefore seems relevant to undertake a larger study to confirm these encouraging preliminary results and better understand the efficacy factors of this device, that represents a new therapeutic option in painful KOA. REFERENCES: [1] Messier et al., Osteoarthritis and Cartilage Open 6 (2024) 100418, doi: 10.1016/j.ocarto.2023.100418 [2] Kulkarny et al ., 2016 Jul:89:22-8, Maturitas, https://doi.org/10.1016/j.maturitas.2016.04.006 [3] Maheu et al. , Therapeutic Advances in Musculoskeletal Disease Volume 14, January-December 2022, https://doi.org/10.1177/1759720X211066233 Acknowledgements: NIL. Disclosure of Interests: Serge Perrot UPSA, Grunenthal, Sanofi, Expanscience, Terkia Medkour: None declared, Anne-Priscille Trouvin: None declared DOI: 10.1136/annrheumdis-2024-eular.4184 Keywords: Pain, Non-pharmacological interventions, Self-management Citation: , volume 83, supplement 1, year 2024, page 667Session: Osteoarthritis and other mechanical musculoskeletal problems (Poster View)

Pain, Non-pharmacological interventions, Self-management