Journal of Paramedical Sciences & Rehabilitation

Journal of Paramedical Sciences & Rehabilitation

Comparison The Eight of Weeks of EMS Training And Hydrotherapy On Pain and Quality of Life In Women With Knee Osteoarthritis

Document Type : Original Article

Authors
Maryam Khademi 1
Alireza Izadi 2
Abdolrasol Daneshjoo 2
1 Department of Sports Injuries and Corrective Exercises, Faculty of Physical Education and Sport Sciences, East Tehran Branch, Islamic Azad University, Tehran, Iran
2 Department of Physical Education and Sport Sciences, East Tehran Branch, Islamic Azad University, Tehran, Iran
10.22038/jpsr.2026.89842.2723
Abstract
Purpose:
Osteoarthritis is a complex pathophysiology that affects joints and supporting structures. The aim of this study was to compare the effect of eight weeks of EMS training and hydrotherapy on pain and quality of life in patients with knee osteoarthritis.
Methods:
The present study was a quasi-experimental study with a pre-test and post-test design. The statistical population of the present study consisted of all women in District 8 of Tehran who had knee osteoarthritis. 45 women with knee osteoarthritis (45-55 years old) were selected conveniently and randomly assigned to three groups: EMS training (15 people), hydrotherapy (15 people) and control (15 people). the experimental group performed their specific exercises for 8 weeks, two 30-minute sessions each week. Pain and quality of life were measured with the Visual Analogue Scale (VAS) and the WHO Quality of Life Questionnaire, respectively. Data were analyzed using the covariance test at a significance level of 0/05.
Results:
And after the exercises, there was a significant difference in pain in the EMS group (η2=0/84, P=0/001) and hydrotherapy (η2=0/8, P=0/001) and quality of life in the EMS group (η2=0/68, P=0/001) and hydrotherapy (η2=0.8, P=0/001). Regarding pain, after controlling for the effect of pre-test scores, the results of the analysis of covariance test showed that there was a significant difference between the groups in pain scores (F41و2=167/86, p=0/001, η2=0/8) and quality of life (F41و2=115/34, p=0/001, η2=0/84). The results of the Bonferroni post hoc test showed that regarding pain, the EMS group showed a difference compared to the control group (3/593) and the hydrotherapy group (1/776) (P=0/001). Regarding quality of life, the mean difference between the EMS group and the control group was (13/184) and (5/947) compared to the hydrotherapy group (P=0/001). Thus, both hydrotherapy and EMS were effective in improving pain and quality of life, but the mean difference between hydrotherapy and EMS in improving quality of life was 5/947 and in reducing pain was 1/817, so EMS exercises resulted in greater improvement in pain and quality of life than hydrotherapy.
Conclusion:
Both exercise programs were effective in improving pain and quality of life, but the results of the Bonferroni post hoc test showed that EMS training was more effective than hydrotherapy training in improving pain and quality of life in women. Future research should investigate the effectiveness of these interventions in men.
Keywords
Hydrotherapy
Electrical Muscle Stimulation (EMS)
Pain
Quality of Life
Knee
  1. Duong V, Oo WM, Ding C, Culvenor AG, Hunter DJ. Evaluation and treatment of knee pain: a review. Jama, 2023; 330(16): 1568-1580.‏
  2. Hsu H, Siwie, RM. Knee osteoarthritis.‏ 2018, 30(6): 168-180.‏
  3. Long H, Liu Q, Yin H, Wang K, et al. Prevalence trends of site-specific osteoarthritis from 1990 to 2019: findings from the global burden of disease study. Arthritis & Rheumatology, 2022; 74(7): 1172-1183.‏
  4. Samut G, Dinçer F, Özdemir O. The effect of isokinetic and aerobic exercises on serum interleukin-6 and tumor necrosis factor alpha levels, pain, and functional activity in patients with knee osteoarthritis. Modern rheumatology, 2015; 25(6): 919-924.‏
  5. Hunter DJ, & Eckstein F. Exercise and osteoarthritis. Journal of anatomy, 2009; 214(2): 197-207.‏
  6. Bispo VA, Bastos JAI, Almeida CCD, Modesto KAG, et al. The effects of neuromuscular electrical stimulation on strength, pain, and function in individuals with knee osteoarthritis: a systematic review with meta-analysis. Fisioterapia E Pesquisa, 2022; 28: 416-426.‏
  7. Turner MN, Hernandez DO, Cade W, Emerson, CP, et al. The role of resistance training dosing on pain and physical function in individuals with knee osteoarthritis: a systematic review. Sports health, 2020; 12(2): 200-206.‏
  8. Hochberg MC, Altman RD, April KT, Benkhalti M, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis care & research, 2012; 64(4): 465-474.‏
  9. Alnahdi AH, Zeni JA, Snyder-Mackler L. Muscle impairments in patients with knee osteoarthritis. Sports health, 2012; 4(4): 284-292.‏
  10. Anwer S, Alghadir A. Effect of isometric quadriceps exercise  on  muscle  strength, pain,  and  function in patients with knee osteoarthritis: a randomized controlled study. Journal of physical therapy science, 2014; 26(5): 745-748.‏
  11. Manheim LM, Dunlop D, Song J, Semanik P, et al. Relationship between physical activity and health-related utility among knee osteoarthritis patients. Arthritis care & research, 2012; 64(7): 1094-1098.‏
  12.  Zeng C, Yang T, Deng ZH, Yang Y, et al. Electrical stimulation for pain relief in knee osteoarthritis: systematic review and network meta-analysis. Osteoarthritis and cartilage, 2015; 23(2): 189-202.‏
  13.  Kawano MM, Araújo ILA, Castro MC, Matos MA. Assessment of quality of life in patients with knee osteoarthritis. Acta ortopedica brasileira. 2015; 23(6), 307-310.‏
  14.  Bartels EM, Juhl CB, Christensen R, Hagen KB, et al. Aquatic exercise for the treatment of knee and hip osteoarthritis. Cochrane Database of Systematic Reviews, 2016; (3).‏
  15.  Lei C, Chen H, Zheng S, Pan Q, et al. The efficacy and safety of hydrotherapy in patients with knee osteoarthritis: a meta-analysis of randomized controlled trials. International Journal of Surgery, 2024; 110(3): 1711-1722.‏
  16.  Teschler M, Mooren FC. (Whole-Body) Electromyostimulation, muscle damage, and immune system: a mini review. Frontiers in Physiology, 2019; 10: 1461.‏
  17.  Brigatto FA, Braz TV, da Costa Zanini TC, et al. Effect of resistance training frequency on neuromuscular performance and muscle morphology after 8 weeks in trained men. The Journal of Strength & Conditioning Research, 2019; 33(8), 2104-2116.
  18.  ‏Kast S, Kemmler W, Roemer FW, Kohl M, et al. Effectiveness of whole-body electromyostimulation on knee pain and physical function in knee osteoarthritis: a randomized controlled trial. Scientific Reports, 2024; 14(1): 20804.‏
  19.  Etesami OS, ZolAktaf V, Esmaili H. Comparison of the effect of 8 weeks of exercise therapy in land and water therapy on functional activities of elderly women with knee osteoarthritis, Iranian Journal of Aging, 2012; 17(2): 154-169. [Persian]
  20.  Briggs-Price S, Mills G, Houchen-Wolloff L, Daynes E, et al. The effects of combining electrical stimulation of the calf and thigh muscles on WOMAC pain in knee osteoarthritis: A double-blind, randomised, sham-controlled trial. Osteoarthritis and Cartilage Open, 2025, 7(2), 100607.‏
  21.  Begum MR, Hossain MA. Validity and reliability of visual analogue scale (VAS) for pain measurement. Journal of Medical Case Reports and Reviews. 2019; 2(11).
  22.  Yao G, Chung CW, Yu CF, Wang JD. Development and verification of validity and reliability of the WHOQOL-BREF Taiwan version. Journal of the Formosan Medical Association. 2002; 101(5):342-351.
  23.  Lin X, Hu Y, Sheng Y. The Effect of Electrical Stimulation Strength Training on Lower Limb Muscle Activation Characteristics During the Jump Smash Performance in Badminton Based on the EMS and EMG Sensors. Sensors. 2025; 25(2): 577.
  24.  Kersten J, Niels T, Tomanek A, Baumann FT. Short-term WB-EMS in Cancer Patients: Positive Effects After 2 Weeks of Exercise—A Single-arm Trial. Integrative Cancer Therapies, 2025; 24: 15-34.
  25. Haghighi M, Miri H, Parkaha S. Comparing the effects of quadriceps strengthening exercises and combined exercises on pain, balance, quality of life and relative strength in women aged 50 to 60 years with osteoarthritis, Journal of Research in Sports Rehabilitation, 2024; 1(1). (Persian)
  26.  Ahmadpour M. Neuromuscular electrical stimulation in the elderly: Multimodal applications of electrical stimulation in the rehabilitation of the elderly, Lifespan Theory, 2024; 2(2): 71-83. (Persian)
  27.  Carvalho MT, Guesser Pinheiro VH, Alberton CL. Effectiveness of neuromuscular electrical stimulation training combined with exercise on patient‐reported outcomes measures in people with knee osteoarthritis: A systematic review and meta‐analysis. Physiotherapy Research International. 2024; 29(1): e2062.
  28.  Shasha Li , Bo Yu, Dong Zh, Chengqi, He, et al. Electromagnetic simulation fields for treating osteoarthritis, Cochrane Database Syst Rev 2013; 14 (12): CD003523.
  29.  Park S, Min S, Park SH, Yoo J, Jee YS. Influence of isometric exercise combined with electromyostimulation on inflammatory cytokine levels, muscle strength, and knee joint function in elderly women with early knee osteoarthritis. Frontiers in physiology, 2021; 12: 688260.‏
  30.  Montisci A, Miceli AA. New weapon in the fight against postcardiac surgery muscle catabolism. The Journal of Thoracic and Cardiovascular Surgery, 2017, 153(2), 379-380.‏
  31.  Ensiye R, Oliveira R, Behrooz Sarvari F, Faeze M, Hadi Mohammadi NS. Virtual reality training and pain neuroscience plus motor control on pain, disability, health, and quality of life of women with non-specific chronic back pain. 2024; 15 (1): 38-45.‏
Journal of Paramedical Sciences & Rehabilitation
Volume 15, Issue 1
Spring 2026
Pages 30-41