not permitted.

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© 2017 EDIZIONI MINERVA MEDICA European Journal of Physical and Rehabilitation Medicine 2018 June;54(3):351-7
Online version at http://www.minervamedica.it DOI: 10.23736/S1973-9087.17.04743-8

ORIGINAL ARTICLE

The effect of interferential current therapy

on patients with subacromial impingement syndrome:
a randomized, double-blind, sham-controlled study
Tuba NAZLIGUL*, Pinar AKPINAR, Ilknur AKTAS,
Feyza UNLU OZKAN, Hulya CAGLIYAN HARTEVIOGLU

Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Training and Research
Hospital, Istanbul, Turkey
*Corresponding author: Tuba Nazligul, Fatih Sultan Mehmet Egitim ve Arastirma Hastanesi Istanbul, Atasehir, Turkey. E-mail: drtuba_@hotmail.com

ABSTRACT
BACKGROUND: Although interferential current (IFC) is a common electrotherapeutic modality used to treat musculoskeletal pain, there is not
any randomized controlled trial investigating its clinical efficacy in subacromial impingement syndrome (SAIS).
AIM: Investigation of effectiveness of IFC treatment in patients with SAIS.
DESIGN: Randomized, double-blind, sham-controlled study.
SETTING: Physical medicine and rehabilitation outpatient clinic.
POPULATION: Patients (N.=65) between 25 and 65 years of age, with a diagnosis of SAIS according to clinical evaluation and subacromial
injection test.
METHODS: Patients were randomly distributed into two groups: 1) active IFC group (N.=33); 2) sham IFC group (N.=32). Exercise, cryo-
therapy, and a non-steroidal anti-inflammatory drug (NSAID) were given to both groups. Ten sessions of IFC with bipolar method were applied
to the active IFC group daily 20 minutes per session, 5 days per week, for 2 weeks while sham IFC was applied to the sham IFC group with the
same protocol. Visual Analog Scale (VAS), Constant scores, and Shoulder Disability Questionnaire (SDQ) were used for evaluation at baseline,
immediately post-treatment, and 1 month post-treatment. Both the patients and the researcher who assessed the outcomes were blinded to the
treatment protocol throughout the study period.
RESULTS: Sixty of the 65 patients (active IFC group N.=30, sham IFC group N.=30) completed the study, 3 patients from active IFC, 2 from
sham IFC group dropped during the follow up period. Statistically significant improvement was observed in all parameters of both groups im-
mediately and 1 month post-treatment (P<0.01). There were no statistical differences between the active IFC group and sham IFC group in all
outcome parameters (P>0.05).
CONCLUSIONS: Our results demonstrated that IFC therapy does not provide additional benefit to NSAID, cryotherapy, and exercise program
in treatment of SAIS.
CLINICAL REHABILITATION IMPACT: Our study responds to the needs of the lack of evidence in the field of rehabilitation. IFC therapy does
not provide additional benefit for the treatment of SAIS.
(Cite this article as: Nazligul T, Akpinar P, Aktas I, Unlu Ozkan F, Cagliyan Hartevioglu H. The effect of interferential current therapy on patients with
subacromial impingement syndrome: a randomized, double-blind, sham-controlled study. Eur J Phys Rehabil Med 2018;54:351-7. DOI: 10.23736/
S1973-9087.17.04743-8)
Key words: Electric stimulation therapy - Shoulder impingement syndrome - Shoulder pain.

S houlder pain is one of the most common site of muscu-

loskeletal pain in the adult population. Its incidence has
due to impingement and inflammation of the rotator cuff
tendons in the subacromial space located between the hu-
or other proprietary information of the Publisher.

been found to range between 6.6 to 25 per 1000 people in meral head and the coracoacromial arcus. The underlying
various studies and subacromial impingement syndrome pathology in SAIS may present as edema, bleeding, fibro-
(SAIS) has been reported to be one of the most frequent sis, tendinitis, and partial or complete rupture of the rota-
etiologic factor for shoulder pain.1 SAIS is known to occur tor cuff tendons, depending on the stage of the syndrome.2

Vol. 54 - No. 3 European Journal of Physical and Rehabilitation Medicine 351

not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, log
means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use i
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NAZLIGUL IFC THERAPY IN PATIENTS WITH SUBACROMIAL IMPINGEMENT SYNDROME
SAIS may develop as a result of several conditions such as
weakness of rotator cuff muscles, abnormality of the acro-
mion, repetitive trauma, and overuse of the shoulder. It is
characterized by shoulder pain accompanied by restriction
of the shoulder range of motion (ROM) and disability in
daily life activities.3
A conservative approach comprising non-steroid
anti-inflammatory drugs (NSAIDs), subacromial in-
jections, exercise, and several physical therapy agents
is recommended as the first step treatment for SAIS.4
Interferential current (IFC) therapy has been used for
many years in the treatment of musculoskeletal disor-
ders for its analgesic, anti-inflammatory, sympatholytic,
local vasodilating, and muscle stimulating effects. Its
effect depends on creation of a low-frequency current
activity in deep tissues by two medium-frequency alter-
native currents of different frequency levels.5
Although IFC has been shown to be effective in sev-
eral musculoskeletal problems such as knee osteoarthritis
and chronic back pain, there is not any randomized and
placebo-controlled study performed to assess its effect on
the treatment of SAIS.6 The purpose of this study was to
investigate the role of IFC therapy in SAIS patients.
Materials and methods
Design overview
A double-blind, sham-controlled clinical trial was carried
out to investigate the effects of IFC therapy on SAIS. The
trial had 2 randomization arms: active IFC and sham IFC
groups.
Setting and participants
One hundred ten patients between the ages of 25 to 65
years, who were appointed to Physical Therapy And Re-
habilitation Outpatient Clinic of the University of Health
Sciences Fatih Sultan Mehmet Training and Research Hos-
pital with a complaint of shoulder pain were evaluated for
inclusion in the study. A careful examination of the neck
and upper extremities, detailed blood analysis, conven-
tional shoulder radiography and magnetic resonance im-
aging (MRI) of neck and shoulder were performed to rule
out abnormalities of the cervical spine and other shoulder
or other proprietary information of the Publisher.
pathologies, and demographic data were recorded. Fol-
lowing these analyses, Subacromial Injection Test (SIT)
was performed to the patients for the differential diagno-
sis. Two percent 5 cc of lidocaine was injected by using 21
352 European Journal of Physical and Rehabilitation Medicine June 2018
G/5 mL needle into subacromial space just under acromi-
on using anterior approach by the same physiatrist during
the SIT procedure. A positive response was determined by
80% or more postinjection reduction in pain intensity and
improvement in passive and/or active ROM 15 minutes
after the injection. The diagnosis of SAIS was confirmed if
SIT and shoulder impingement tests (Neer and Hawkins-
Kennedy) were positive.7, 8
The exclusion criterias were as follows: 1) concomi-
tant shoulder pathologies such as adhesive capsulitis, cal-
cific tendinitis, full-thickness tears of the rotator cuff, os-
teoarthritis of the acromioclavicular joint, dislocations or
acute traumatic conditions; 2) prior applications of phys-
iotherapy and injection of hyaluronic acid and/or cortico-
steroid during the preceding 3 months; 3) previous shoul-
der surgery; 4) cervical pain or other conditions such as
fibromyalgia conflicting the clinical picture; 5) malig-
nancy; 6) neurologic motor and/or sensory deficiency in
the upper extremity; 7) pregnancy; 8) acute infection; 9)
inflammatory disease; and 10) cardiac pace-maker.
Sixty-five patients who were found eligible for the
study were randomly allocated into the active IFC
(N.=33) and sham IFC (N.=32) groups. All baseline and
post-treatment evaluations were done by the same phys-
iatrist with more than 5 years of clinical experience. Both
Enrollment Assessed for eligibility (N.=110)
Excluded (N.=45)
- Not meeting inclusion criteria
(N.=36)
- Declined to participate (N.=6)
- Other reasons (N.=3)
Randomized (N.=65)
Allocation
Allocated to IFC therapy (N.=33) Allocated to sham therapy (N.=32)
- Received allocated intervention (N.=33) - Received allocated intervention (N.=32)
- Did not receive allocated intervention
(N.=0)
- Did not receive allocated intervention
(N.=0)
Follow-up
Lost to follow-up
(unable to contact) (N.=2)
Lost to follow-up
(unable to contact) (N.=1)
Discontinued intervention Discontinued intervention
(withdrawal due to a new job) (N.=1) (stated no reason) (N.=1)
Analysis
Analyzed (N.=30) Analyzed (N.=30)
- Excluded from analysis (N.=0) - Excluded from analysis (N.=0)
Figure 1.—CONSORT flow diagram of participants in the study.
not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, log
means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use i
This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies
(either sporadically or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other
©
COPYRIGHT 2018 EDIZIONI MINERVA MEDICA
IFC THERAPY IN PATIENTS WITH SUBACROMIAL IMPINGEMENT SYNDROME NAZLIGUL
the physiatrist and the patients were blinded to the treat-
ment protocol throughout the study period (Figure 1).
All patients provided written informed consent after
receiving a detailed information sheet describing the
study protocol. The study protocol was approved by the
Fatih Sultan Mehmet Training and Research Hospital
Ethics Committee (approval number: 2015/10), and
was conducted in accordance with the Helsinki Decla-
ration of 1975, as revised in 2004.
Randomization and interventions
In this randomized, double-blind study, a researcher not
involved with data collection performed the randomiza-
tion using random number generation in the software Mi-
crosoft Excel for Windows. The allocation was concealed
in sequentially numbered opaque sealed envelopes. After
the assessment, the eligible patients were randomly allo-
cated into the groups by the physiotherapist responsible
for the electrotherapy.
A pair of disposable electrodes (90x50 mm) were
placed on the affected shoulder of the patient in the sit-
ting position in both groups. In active IFC group, bipolar
IFC was applied 5 days a week, for a total of 10 sessions
during 2 weeks, using the ITO EU-940 electrotherapy
device. The medium frequency of the interferential cur-
rent was 4000 Hz and 4100 Hz to produce the ampli-
tude-modulated frequency at 100 Hz.9 The physiothera-
pist increased the current amplitude until the participant
felt a strong but comfortable tingling. Every 5 minutes,
the physiotherapist asked each participant whether the
“strong but comfortable tingling” remained. In case of
sensory habituation, the current amplitude was increased
until the participant reached the previous sensation.10 The
duration of the stimulation was 20 minutes.6
In the sham IFC group, IFC was applied in the same
way with the light of the electrotherapy device switched
on but without any current. Participants were told that
they would receive an electrical stimulation treatment
for pain relief and that they may or may not feel a very
light tingling sensation in the shoulder during the elec-
trical stimulation. To indicate the end of the application,
the device made the same sound as the active current.
The same physiotherapist with over 10 years of clinical
or other proprietary information of the Publisher.
experience in electrotherapy, was in charge of interven-
tion in both groups.
Both groups were given instructions on a conserva-
tive treatment program which contains Codman’s pen-
Vol. 54 - No. 3 European Journal of Physical and Rehabilitation Medicine 353
dulum exercises (5 sets a day/5 minutes each set), cold
pack application (with cold pack gel, 4 times a day, 20
minutes per session) on the affected shoulder, restric-
tion of daily activities that require the hands to be used
over the head and sleeping on the affected shoulder, and
oral meloxicam 15 mg daily for two weeks.
Outcomes and follow-up
All participants were evaluated at pretreatment, immedi-
ately post-treatment, and 1 month post-treatment. Demo-
graphic data, the onset and duration of the complaints,
hand dominance, Visual Analog Scale (VAS), Constant-
Murley Scale (CMS), and Shoulder Disability Question-
naire (SDQ) scores were recorded at the baseline assess-
ment. VAS, CMS, and SDQ scores which were the study’s
main independent variables, were re-recorded at the im-
mediately post-treatment and 1 month post-treatment as-
sessments. VAS (score 0 means no pain, score of 10 mean
the worst pain ever) was used to quantify the pain level
during rest, activity, and night periods.11
CMS was used to assess the functional status of the
affected shoulder. The CMS is a standardized clinical
evaluation tool with a score ranging from 0 to 100 based
on evaluation of four parameters: pain (15 points), dai-
ly life activities (20 points), active ROM (40 points),
and muscle strength (25 points).12 The higher the CMS
score, the better the functional status of the shoulder is.
Daily living activities were evaluated by SDQ. The
SDQ is a pain-related disability questionnaire, which
contains 16 items describing common situations that
may induce symptoms in patients with shoulder disor-
ders. All items refer to the preceding 24 hours. Response
options are either “yes,” “no,” or “not applicable”. The
‘not applicable’ category should be used when the situ-
ation at issue has not occurred during the preceding 24
hours. A final score is calculated by dividing the number
of items with a positive score by the total number of ap-
plicable items and subsequently multiplying this num-
ber by 100. Final score ranges between 0 (no disability)
and 100 (all applicable items positive).13 The Turkish
version of the SDQ was reported to be valid and reliable
by Ozsahin et al.14
Statistical analysis
Calculations for estimating sample size were based on de-
tecting a 30% improvement in pain scores, according to
previously conducted study by Galace de Freitas et al.,15
not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, log
means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use i
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NAZLIGUL IFC THERAPY IN PATIENTS WITH SUBACROMIAL IMPINGEMENT SYNDROME

assuming α: 0.05, and power: 0.80. A sample size of 29
subjects per group was determined and follow-up loss of
10% were considered. For this calculation G*Power anal-
ysis program was used.
Statistical analysis of data was performed by using
IBM SPSS Statistics 22 (IBM SPSS, Turkey) program.
Shapiro-Wilk Test was used to check whether the data
is normally distributed. Besides descriptive statistical
methods (mean, standard deviation, frequency), inter-
group comparisons were done by Student’s t-test and
Mann-Whitney U Test for the parameters with normal
and non-normal distribution, respectively. An analysis
of variance for repeated measures (pretreatment, im-
mediately and 1 month after treatment) was used to
evaluate the differences between groups with normal
distribution. Bonferroni adjustment was carried out for
calculation of the time creating the difference. Friedman
Test was used for the comparison of the parameters with
non-normal distribution and Wilcoxon Sign Rank Test
was used for calculation of the time creating the differ-
ence. Significance was evaluated at the level of P<0.05.
Results
The study was conducted from December 2015 to June 2016.
A total of 110 patients were assessed and 65 were eligible and

Table I.—Participant characteristics at baseline.

Variable Sham IFC Active IFC P
Age (y) x (SD) 48.90 (9.40) 51.13 (8.80) 0.34
Gender N. (%) Female 15 (50) 19 (63.3) 0.43
Male 15 (50) 11 (36.7)
BMI (kg/m2) mean (SD) 27.04 (4.34) 28.15 (5.39) 0.38
Pain duration (week) mean (SD) 21.30 (27.17) 20.47 (23.10) 0.76
State of education N. (%) None 3 (10) 1 (3.3) 0.41
Primary school 16 (53.3) 19 (63.3)
Secondary school 6 (20) 8 (26.7)
University 5 (16.7) 2 (6.7)
Upper extremity use in occupation N. (%) Yes 16 (53.3) 20 (66.7) 0.07
No 14 (46.7) 10 (33.3)
Dominant hand N. (%) Right 30 (100) 27 (90) 0.23
Left 0 (0) 3 (10)
Affected side N. (%) Right 18 (60) 15 (50) 0.60
Left 12 (40) 15 (50)
Night pain N. (%) No 7 (23.3) 6 (20) 1.00
Yes 23 (76.7) 24 (80)
IFC: interferential current; SD: standard deviation; BMI: Body Mass Index.

Table II.—Comparison of resting, activity and night VAS Scores at baseline, post-treatment and 1 month post-treatment.
Sham IFC Active IFC
VAS 95% CI for the difference P
Mean (SD) Mean (SD)
Resting Baseline 2.53 (2.45) 2.87 (2.43) (-1.59, 0.93) 0.53
Post-treatment 1.10 (1.37) 1.07 (1.46) (-0.7, 0.77) 0.83
1 month 0.77 (1.25) 0.93 (1.44) (-0.86, 0.53) 0.63
p1 0.001 0.001
Activity Baseline 7.87 (1.76) 7.73 (1.82) (-0.79, 1.06) 0.76
Post-treatment 4.40 (2.16) 4.30 (1.73) (-0.91, 1.11) 0.91
1 month 3.47 (2.86) 3.90 (2.22) (-1.76, 0.89) 0.21
p1 0.001 0.001
Night Baseline 6.13 (3.31) 6.40 (3.05) (-1.91, 1.38) 0.83
or other proprietary information of the Publisher.

Post-treatment 3.07 (2.72) 3.00 (2.10) (-1.19, 1.32) 0.88

1 month 1.93 (2.49) 2.67 (2.67) (-2.07, 0.6) 0.23
p1 0.001 0.001
CI: confidence interval; IFC: interferential current; S: standard deviation; VAS: Visual Analogue Scale; p1: baseline — post-treatment and baseline, — 1 month within-
group differences.

354 European Journal of Physical and Rehabilitation Medicine June 2018

not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, log
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IFC THERAPY IN PATIENTS WITH SUBACROMIAL IMPINGEMENT SYNDROME NAZLIGUL

agreed to participate to the study. From 65 patients enrolled,
33 patients were randomized to the active IFC, 32 patients to
the sham IFC group. Three patients in the active IFC group
and 2 patients in the sham IFC group withdrew during the
follow-up period and the evaluations were done for the re-
maining 60 patients (34 females and 26 males). A flow dia-
gram of the patient allocation is presented in Figure 1.
The mean age of the study patients was 50.02±9.10
years. No significant difference was found between the
active IFC (N.=30) and sham IFC (N.=30) groups for
age, gender, Body Mass Index, upper extremity use in
occupation, and education (P>0.05). Other than gender
and upper extremity use in occupation, no significant
difference was found between the active IFC and sham
IFC groups for disease-related variables of pain dura-
tion, dominant hand, affected shoulder, and night pain
(P>0.05). There were more women and upper extremity
user in the active IFC group. The characteristics of par-
ticipants were presented in the Table I.
Significant improvement in all parameters was ob-
served on immediately post-treatment and 1 month
post-treatment assessments compared to pretreatment
assessments in both groups (P<0.01). Comparison of
the VAS, CMS, and SDQ scores between the two groups
did not show any significant difference either before or
after treatment (P>0.05) (Table II-IV).
All patients tolerated the treatments well and no ad-
verse events were found related to the treatments.

Table III.—Comparison of Constant-Murley Scale and its subscale scores at baseline, post-treatment and 1 month post-treatment.
Sham IFC Active IFC
Constant Mean (SD) Mean (SD) 95% CI for the difference P

Pain Baseline 0.67 (1.73) 0.67 (1.73) (-0.89, 0.89) 1.00

Post-treatment 5.67 (3.65) 6.17 (3.39) (-2.32, 1.32) 0.60
1 month 8.17 (4.45) 7.67 (3.88) (-1.66, 2.66) 0.51
p1 0.001 0.001
Daily life activities Baseline 10.73 (3.58) 10.20 (3.61) (-1.33, 2.39) 0.67
Post-treatment 15.13 (3.09) 15.00 (3.43) (-1.56, 1.82) 0.72
1 month 16.67 (3.69) 16.00 (3.28) (-1.14, 2.47) 0.30
p1 0.001 0.001
ROM Baseline 20.27 (8.00) 19.20 (8.28) (-3.14, 5.27) 0.61
Post-treatment 27.27 (6.82) 26.73 (7.71) (-3.23, 4.29) 0.77
1 month 29.27 (7.47) 28.27 (6.70) (-2.67, 4.67) 0.58
p1 0.001 0.001
Strength Baseline 5.80 (2.99) 5.50 (3.63) (-1.42, 2.02) 0.45
Post-treatment 7.33 (3.83) 7.10 (4.35) (-1.88, 2.35) 0.65
1 month 8.23 (5.94) 7.10 (4.63) (-1.62, 3.89) 0.49
p1 0.005 0.001
Total Baseline 37.07 (10.94) 35.50 (12.83) (-4.59, 7.73) 0.61
Post-treatment 55.40 (12.21) 54.70 (14.40) (-6.2, 7.6) 0.84
1 month 62.17 (17.32) 58.57 (14.21) (-4.59, 11.79) 0.38
p1 0.001 0.001
CI: confidence interval; IFC: interferential current; SD: standard deviation; ROM: range of motion; p1: baseline — post-treatment and baseline — 1 month within-group
differences.

Table IV.—Comparison of Shoulder Disability Questionnaire scores at baseline, post-treatment and 1 month post-treatment.
Sham IFC Active IFC
SDQ 95% CI for the difference P
Mean (SD) Mean (SD)
Baseline 77.37 (17.35) 84.90 (14.45) (-15.78, 0.72) 0.07
or other proprietary information of the Publisher.

Post-treatment 57.77 (20.90) 59.07 (26.31) (-13.59, 10.99) 0.83

1 month 46.87 (25.09) 55.37 (23.7) (-21.11, 4.11) 0.18
p1 0.001 0.001
CI: confidence interval; IFC: interferential current; SD: standard deviation; SDQ: Shoulder Disability Questionnaire; p1: baseline — post-treatment and baseline — 1
month within-group differences.

Vol. 54 - No. 3 European Journal of Physical and Rehabilitation Medicine 355

not permitted. It is not permitted to remove, cover, overlay, obscure, block, or change any copyright notices or terms of use which the Publisher may post on the Article. It is not permitted to frame or use framing techniques to enclose any trademark, log
means which may allow access to the Article. The use of all or any part of the Article for any Commercial Use is not permitted. The creation of derivative works from the Article is not permitted. The production of reprints for personal or commercial use i
This document is protected by international copyright laws. No additional reproduction is authorized. It is permitted for personal use to download and save only one file and print only one copy of this Article. It is not permitted to make additional copies
(either sporadically or systematically, either printed or electronic) of the Article for any purpose. It is not permitted to distribute the electronic copy of the article through online internet and/or intranet file sharing systems, electronic mailing or any other
©
COPYRIGHT 2018 EDIZIONI MINERVA MEDICA
NAZLIGUL IFC THERAPY IN PATIENTS WITH SUBACROMIAL IMPINGEMENT SYNDROME
Discussion
SAIS is a common cause of shoulder pain and can lead to
a decrease in the function of this joint. The basic goals of
treatment of SAIS are to relieve pain and inflammation,
reestablish non-painful ROM and improving shoulder
function.16 Basic rehabilitation program of SAIS includes
exercise (Codman’s pendulum exercises and symptom-
limited, active, assisted ROM exercises) and a period of
relative rest, eliminating any activity that may cause an
increase in symptoms. Cryotherapy, IFC, therapeutic ul-
trasound, magnetic field therapy, laser therapy, extracor-
poreal shock wave therapy, and transcutaneous electrical
nerve stimulation are also used as supplementary physical
therapy agents.17
IFC is a form of electrical stimulation which depends
on creation of a low-frequency current effect in deep
tissues by two medium-frequency alternative currents
at different frequencies. Since the skin resistance de-
creases with the increasing current frequency, IFC may
exert its effect on deeper tissue planes without patient
discomfort.18 IFC therapy did not provide any addition-
al benefit where it was used together with exercise in
the treatment of non-specific shoulder soft tissue disor-
ders.19 On the other hand, Cheing et al. reported signifi-
cant pain relief and functional improvement with IFC
therapy in patients with frozen shoulder.20 Furthermore,
the latest Cochrane Review of electrotherapy for rota-
tor cuff disease (RCD) revealed low level of evidence.21
There is no randomized controlled study investigating
the effect of IFC on SAIS thus far.
We investigated the efficacy of IFC therapy in addi-
tion to relative resting, cryotherapy, NSAID, and pen-
dulum exercises in the treatment of SAIS. We obtained
statistically significant improvement in comparison
with the baseline values in scores of rest, activity and
night pain on VAS, Constant total and its sub-sectional
parameters, and SDQ in both groups. However, there
was no statistical difference between the active IFC and
sham IFC groups in all outcome parameters.
The effect of IFC therapy has been investigated in
several musculoskeletal disorders such as knee osteo-
arthritis and chronic low back pain. A meta-analysis
investigating the effectiveness of IFC therapy in the
or other proprietary information of the Publisher.
management of musculoskeletal pain revealed that, IFC
is not significantly better than placebo or other inter-
ventions as an isolated treatment. They suggested that
it would be more effective when it was used as a part of
356 European Journal of Physical and Rehabilitation Medicine June 2018
a multimodal treatment plan.6 So, we investigated the
additional effect of IFC to baseline treatment of SAIS.
We observed night pain, which may be the sign of ac-
tive inflammation, in 24 (80%) patients in the active IFC
group and 23 (76.7%) patients in the sham IFC group.
Previous reports have demonstrated that proinflamma-
tory cytokines were found at high levels in the subacro-
mial bursa of patients with RCD.22-25 In another study,
Okamura et al. showed the increased concentration of
IL-8 is associated with resting pain in these patients.26
In our study, NSAID and cryotherapy treatment would
have contributed to overall improvement by suppress-
ing the inflammation.
In patients with SAIS, cryotherapy and pendulum ex-
ercises have been shown to relieve pain and improve
function significantly.27 In another study, exercise has
been reported to be more effective than placebo both in
the short term and midterm (moderate evidence).28 Ak-
tas et al. found no difference between two groups of
patients with SAIS who were given a combination of
NSAID, cryotherapy, and pendulum exercises with or
without additional pulsed electromagnetic field.29 In our
study, also both groups were given NSAID, cryothera-
py, and pendulum exercises.
Limitations of the study
Our results showed that IFC therapy had no additional
benefit over these therapies supporting these studies. How-
ever, we investigated only the short-term effects of IFC
therapy. It was the limitation of our study. There would be
different results if the long-term effects of IFC therapy was
investigated.
Conclusions
The results of our study suggest that, IFC therapy does
not provide additional benefit to NSAID, cryotherapy, and
exercise program in the treatment of SAIS. Further studies
investigating the long-term effects of IFC may contribute
to better understanding of the subject.
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Conflicts of interest.—The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.
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