Effects of Electromyographic Biofeedback on Quadriceps Strength: A Systematic Review

2012 ◽  
Vol 26 (3) ◽  
pp. 873-882 ◽  
Author(s):  
Adam S Lepley ◽  
Phillip A Gribble ◽  
Brian G Pietrosimone
Keyword(s):  
Systematic Review ◽  
Quadriceps Strength ◽  
Electromyographic Biofeedback

Effects of electromyographic biofeedback interventions for shoulder pain and function: Systematic review and meta-analysis

2021 ◽  
pp. 026921552199095
Author(s):  
Danilo Harudy Kamonseki ◽  
Letícia Bojikian Calixtre ◽  
Rodrigo Py Gonçalves Barreto ◽  
Paula Rezende Camargo
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Confidence Interval ◽  
Shoulder Pain ◽  
Meta Analysis ◽  
Quality Of Evidence ◽  
Electromyographic Biofeedback ◽  
Mean Differences ◽  
And Function

Objective: To systematically review the effectiveness of electromyographic biofeedback interventions to improve pain and function of patients with shoulder pain. Design: Systematic review of controlled clinical trials. Literature search: Databases (Medline, EMBASE, CINAHL, PEDro, CENTRAL, Web of Science, and SCOPUS) were searched in December 2020. Study selection criteria: Randomized clinical trials that investigated the effects of electromyographic biofeedback for individuals with shoulder pain. Patient-reported pain and functional outcomes were collected and synthesized. Data synthesis: The level of evidence was synthesized using GRADE and Standardized Mean Differences and 95% confidence interval were calculated using a random-effects inverse variance model for meta-analysis. Results: Five studies were included with a total sample of 272 individuals with shoulder pain. Very-low quality of evidence indicated that electromyographic biofeedback was not superior to control for reducing shoulder pain (standardized mean differences = −0.21, 95% confidence interval: −0.67 to 0.24, P = 0.36). Very-low quality of evidence indicated that electromyographic biofeedback interventions were not superior to control for improving shoulder function (standardized mean differences = −0.11, 95% confidence interval: −0.41 to 0.19, P = 0.48). Conclusion: Electromyographic biofeedback may be not effective for improving shoulder pain and function. However, the limited number of included studies and very low quality of evidence does not support a definitive recommendation about the effectiveness of electromyographic biofeedback to treat individuals with shoulder pain.

Effect of Adductor Canal Block Versus Femoral Nerve Block on Quadriceps Strength, Function, and Postoperative Pain After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Level 1 Studies

2019 ◽  
Vol 48 (9) ◽  
pp. 2305-2313 ◽  
Author(s):  
Matthew Dean Edwards ◽  
Joseph Preston Bethea ◽  
Jennifer Lee Hunnicutt ◽  
Harris Scott Slone ◽  
Shane Kelby Woolf
Keyword(s):  
Systematic Review ◽  
Femoral Nerve Block ◽  
Cruciate Ligament ◽  
Femoral Nerve ◽  
Quadriceps Strength ◽  
Pain Scores ◽  
Functional Measures ◽  
Anterior Cruciate ◽  
Straight Leg Raise

Background: Femoral nerve block (FNB) is a popular technique for reducing postoperative pain in patients with anterior cruciate ligament reconstruction (ACLR), but it is also linked to a number of adverse effects, such as quadriceps weakness, antalgic ambulation, and increased fall risk. Adductor canal block (ACB) has been offered as a motor nerve–sparing alternative to FNB. Purpose: To evaluate available literature that compares the effects of ACB and FNB on functional outcomes after arthroscopic ACLR. Study Design: Systematic review. Methods: Following the 2009 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a search of PubMed (Ovid), CINAHL, Scopus, Cochrane, and Google Scholar databases was conducted. Search terms were designed to capture studies comparing the effects of ACB and FNB in patients undergoing arthroscopic ACLR. Data were evaluated regarding study and patient characteristics, functional measures, opioid consumption, pain scores, and complications. Results: Eight randomized controlled trials (N = 655 patients) comparing the efficacy of ACB versus FNB in arthroscopic ACLR were included. The heterogeneity of outcome measures precluded meta-analysis. Seven studies reported functional measures, which included isokinetic strength, straight-leg raise, and other various measures. Follow-up periods varied between 1 hour and 6 months. In 3 trials, ACB was found to preserve quadriceps strength as measured using straight-leg raise for the first 12 to 24 hours after surgery, while 3 other trials found no difference between the groups. No differences were reported in isokinetic strength at 6 months. In other functional measures, ACB either outperformed or was equivalent to FNB. The majority of studies reporting opioid consumption, pain scores, and complications found no differences between the blocks. Conclusion: This systematic review suggests that when compared with FNB, ACB preserves quadriceps function in the early postoperative period after ACLR while providing a similar level of analgesia. Limitations of this study include the use of various functional measures and limited long-term follow-up. More research evaluating long-term functional outcomes with standardized measures is needed to draw adequate conclusions regarding the effects of ACB and FNB on function after ACLR.

scholarly journals Quadriceps Strength After Anterior Cruciate Ligament Reconstruction Compared With Uninjured Matched Controls: A Systematic Review and Meta-analysis

2021 ◽  
Vol 9 (4) ◽  
pp. 232596712199153
Author(s):  
Conlan Brown ◽  
Lee Marinko ◽  
Michael P. LaValley ◽  
Deepak Kumar
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Matched Control ◽  
Cruciate Ligament ◽  
Quadriceps Strength ◽  
Injured Limb ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Background: The limb symmetry index may overestimate the recovery of quadriceps muscle strength after anterior cruciate ligament reconstruction. Comparison of individuals who have had anterior cruciate ligament reconstruction with age-, sex-, and activity-matched individuals might be more appropriate to guide rehabilitation interventions. Purpose: To compare the quadriceps strength between the injured limb of people with anterior cruciate ligament reconstruction and the limb of an age-, sex-, and activity-matched control group. Study Design: Systematic review; Level of evidence, 3. Methods: MEDLINE, CINAHL, EMBASE, SCOPUS, and SPORTDiscus were searched between inception and April 2019. Studies were included if they reported the peak quadriceps strength for persons with anterior cruciate ligament reconstruction and age-, sex-, and activity-matched control groups measured using isometric or isokinetic dynamometry. Risk of bias was assessed, and meta-analyses and metaregression (for effect of time since surgery) were performed. Results: A total of 2759 studies were identified and 21 were included for analyses. Quadriceps strength was lower in the limbs with anterior cruciate ligament reconstruction compared with the limb from matched controls within 6 months of anterior cruciate ligament reconstruction (standardized mean difference [SMD], –1.42; 95% CI, –1.62 to –1.23), 6 to 18 months after anterior cruciate ligament reconstruction (SMD, –0.92; 95% CI, –1.18 to –0.66), and >18 to 48 months after anterior cruciate ligament reconstruction (SMD, –0.38; 95% CI, –0.79 to 0.03). Results of the metaregression were significant, with the difference between anterior cruciate ligament reconstruction and matched controls decreasing with time since surgery ( P < .001). Conclusion: In people with anterior cruciate ligament reconstruction, the injured limb had lower quadriceps strength compared with the limb of age-, sex-, and activity-matched controls up to 4 years after surgery. Clinicians should consider comparison with matched cohorts for return to sports decision making.

scholarly journals A Comparison of Neuromuscular Electrical Stimulation Parameters for Postoperative Quadriceps Strength in Patients After Knee Surgery: A Systematic Review

2021 ◽  
Vol 13 (2) ◽  
pp. 116-127
Author(s):  
Caitlin E.W. Conley ◽  
Carl G. Mattacola ◽  
Kate N. Jochimsen ◽  
Emily V. Dressler ◽  
Christian Lattermann ◽  
...  
Keyword(s):  
Systematic Review ◽  
Electrical Stimulation ◽  
Health Care Providers ◽  
Neuromuscular Electrical Stimulation ◽  
Quadriceps Strength ◽  
Knee Surgery ◽  
Effect Sizes ◽  
Care Providers ◽  
Level Of Evidence ◽  
Evidence Database

Context: Postoperative quadriceps strength weakness after knee surgery is a persistent issue patients and health care providers encounter. Objective: To investigate the effect of neuromuscular electrical stimulation (NMES) parameters on quadriceps strength after knee surgery. Data Sources: CINAHL, MEDLINE, SPORTDiscus, and PubMed were systematically searched in December 2018. Study Selection: Studies were excluded if they did not assess quadriceps strength or if they failed to report the NMES parameters or quadriceps strength values. Additionally, studies that applied NMES to numerous muscle groups or simultaneously with other modalities/treatments were excluded. Study quality was assessed with the Physiotherapy Evidence Database (PEDro) scale for randomized controlled trials. Study Design: Systematic review. Level of Evidence: Level 1. Data Extraction: Treatment parameters for each NMES treatment was extracted for comparison. Quadriceps strength means and standard deviations were extracted and utilized to calculate Hedge g effect sizes with 95% CIs. Results: Eight RCTs were included with an average Physiotherapy Evidence Database scale score of 5 ± 2. Hedge g effect sizes ranged from small (−0.37; 95% CI, −1.00 to 0.25) to large (1.13; 95% CI, 0.49 to 1.77). Based on the Strength of Recommendation Taxonomy Quality of Evidence table, the majority of the studies included were low quality RCTs categorized as level 2: limited quality patient-oriented evidence. Conclusion: Because of inconsistent evidence among studies, grade B evidence exists to support the use of NMES to aid in the recovery of quadriceps strength after knee surgery. Based on the parameters utilized by studies demonstrating optimal treatment effects, it is recommended to implement NMES treatment during the first 2 postoperative weeks at a frequency of ≥50 Hz, at maximum tolerable intensity, with a biphasic current, with large electrodes and a duty cycle ratio of 1:2 to 1:3 (2- to 3-second ramp).

scholarly journals Neuromuscular risk factors for non-contact knee injury: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Bonar McGuire ◽  
Ben King
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Body Mass ◽  
Knee Injury ◽  
Meta Analysis ◽  
Knee Injuries ◽  
Acl Injury ◽  
Quadriceps Strength ◽  
Case Control Studies ◽  
Military Recruits

ABSTRACTObjectivesIdentify neuromuscular risk factors for non-contact knee injury, using a systematic review and meta-analysis, to inform the development of preventive strategies.MethodsMedline, Web of Science and SCOPUS were searched from inception until November 2020. Prospective and nested case-control studies that analysed baseline neuromuscular characteristics as potential risk factors for subsequent non-contact knee injuries were included. Two reviewers independently appraised methodological quality using a modified Newcastle–Ottawa Scale. Meta-analysis was performed where appropriate, with standardised mean differences calculated for continuous scaled data.ResultsSeventeen studies were included, comprising baseline data from 5,584 participants and 415 non-contact knee injuries (heterogeneous incidence = 7.4%). Protocols and outcome measures differed across studies, limiting data pooling. Twenty-one neuromuscular variables were included in the meta-analysis. Three were identified as risk factors. For patellofemoral pain, among military recruits: reduced non-normalised quadriceps strength at 60º/s (SMD −0.66; 95% CI −0.99, −0.32); reduced quadriceps strength at 240º/s (normalised by body mass) (SMD −0.53; CI −0.87, −0.20). For PFP/ACL injury among female military recruits: reduced quadriceps strength at 60º/s (normalised by body mass) (SMD −0.50; CI −0.92, −0.08).ConclusionsQuadriceps weakness is a risk factor for PFP among military recruits, and for PFP/ACL injury among female military recruits. However, the effect sizes are small, and the generalisability of these findings is limited. The effectiveness of quadriceps strengthening interventions for preventing PFP and ACL injury merits evaluation in prospective randomised trials.

scholarly journals Perioperative and Postoperative Factors Influence Quadriceps Atrophy and Strength After ACL Reconstruction: A Systematic Review

2020 ◽  
Vol 8 (6) ◽  
pp. 232596712093029
Author(s):  
Jacqueline E. Baron ◽  
Emily A. Parker ◽  
Kyle R. Duchman ◽  
Robert W. Westermann
Keyword(s):  
Systematic Review ◽  
Blood Flow ◽  
Acl Reconstruction ◽  
Nerve Block ◽  
Quadriceps Strength ◽  
Nutritional Supplementation ◽  
Blood Flow Restriction ◽  
Thigh Circumference ◽  
Flow Restriction ◽  
Level 1

Background: Quadriceps dysfunction after anterior cruciate ligament (ACL) reconstruction is common and may affect return to sport due to resulting muscle atrophy and muscle weakness. Purpose: To systematically review the available literature regarding the impact of perioperative and postoperative interventions on quadriceps atrophy and loss of strength after ACL reconstruction. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review was performed in accordance with the 2009 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed, CINAHL, Cochrane Central, and Embase. The quality of evidence was evaluated using the Modified Coleman Methodology Score to determine consensus scores. Eligible level 1 or level 2 studies included interventions of perioperative nerve block, intraoperative tourniquet use, postoperative nutritional supplementation, and postoperative blood flow restriction training. Additionally, the included studies quantified postoperative quadriceps measurements such as thigh circumference, quadriceps cross-sectional area (CSA), isokinetic quadriceps strength, and/or quadriceps electromyographic (EMG) testing. Results: In total, 15 studies met stated inclusion and exclusion criteria with the following intervention types: perioperative nerve block (n = 4), intraoperative tourniquet use (n = 5), postoperative nutritional supplementation (n = 3), and postoperative blood flow restriction (n = 3). Intraoperative tourniquet use resulted in decreased thigh circumference and detrimental EMG changes in quadriceps function in 3 of the 5 included studies. Perioperative femoral nerve blocks were associated with transient decreases in postoperative quadriceps strength, persisting up to 6 weeks after surgery, in 2 of the 4 studies. Postoperative blood flow restriction training augmented quadriceps size and function after ACL reconstruction in 2 of 3 studies. Postoperative nutritional supplementation was associated with increased quadriceps volume and strength in 1 of the 3 studies examined. Conclusion: The peri- and postoperative factors reviewed here may influence quadriceps atrophy and strength after ACL reconstruction. Our results tentatively indicated that blood flow restriction training may be beneficial to the quadriceps after ACL reconstruction and that intraoperative tourniquet use and nerve block administration may be detrimental; however, the strongest finding was that all of these interventions would benefit from further level 1 and 2 evidence studies, including multicenter, randomized controlled trials with extended follow-up, to definitively determine their impact on return to activity.

Effects of Whole-Body Vibration Therapy on Quadriceps Function in Patients With Anterior Cruciate Ligament Reconstruction: A Systematic Review

2021 ◽  
pp. 194173812110049
Author(s):  
Jihong Qiu ◽  
Michael Tim-Yun Ong ◽  
Hio Teng Leong ◽  
Xin He ◽  
Sai-Chuen Fu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cruciate Ligament ◽  
Quadriceps Strength ◽  
Whole Body ◽  
Single Session ◽  
Quality Of Evidence ◽  
Activation Ratio ◽  
Anterior Cruciate ◽  
Quadriceps Function

Context: Quadriceps dysfunction is common for patients after anterior cruciate ligament reconstruction (ACLR). Whole-body vibration (WBV) could effectively treat quadriceps dysfunction. Objective: To summarize WBV protocols for patients with ACLR and to evaluate the effects of WBV on quadriceps function. Data Sources: PubMed, CINAHL, SportDiscus, Web of Science, Medline, and Embase were searched from inception to January 2020. Study Selection: Randomized controlled trials recruiting patients with ACLR, using WBV as intervention, and reporting at least 1 of the following outcomes, strength, rate of torque development (RTD), and voluntary activation ratio of quadriceps, were included. Study Design: Systematic review. Evidence Level: Level 3. Methods: This systematic review was reported according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Quality of evidence was determined by PEDro criteria and GRADE system. Participant characteristics, interventions, and the relevant results of the included studies were extracted and synthesized in a narrative way. Results: In total, 8 studies were included. Of these, 2 studies had serious risk of bias. Five of 8 studies implemented a series of WBV program ranging from 2 to 10 weeks in duration, while the other 3 studies implemented a single session of WBV. Eight WBV protocols were reported. The reported outcomes consisted of quadriceps strength, RTD, and central activation ratio. WBV protocols were heterogeneous. Low quality of evidence supported that exclusive conventional rehabilitation was more effective than exclusive WBV therapy in increasing quadriceps strength. Low quality of evidence supported that WBV combined with conventional rehabilitation was more beneficial in increasing quadriceps strength when compared with conventional rehabilitation alone. Very low quality of evidence supported the efficacy of a single session of WBV on quadriceps function. Conclusions: There is no standardized WBV protocol for patients with ACLR, and the effectiveness of WBV in rehabilitation on quadriceps function remains inconclusive.

scholarly journals The effectiveness of preoperative rehabilitation programmes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction: a systematic review

2020 ◽  
Vol 8 (9_suppl7) ◽  
pp. 2325967120S0052
Author(s):  
Hayley Carter ◽  
Chris Littlewood ◽  
Kate E. Webster ◽  
Benjamin E. Smith
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Quadriceps Strength ◽  
Risk Of Bias ◽  
Postoperative Outcomes ◽  
Perturbation Training ◽  
Operative Outcomes ◽  
Anterior Cruciate

Introduction: The anterior cruciate ligament (ACL) is the most commonly injured ligament in the knee with annual incidence rates of ruptures reported at 68.6 per 100,000. ACL ruptures are commonly treated with surgical reconstruction which aims to restore knee stability and maximise functional capacity to allow individuals to return to their preinjury level of physical activity. Prior to ACL reconstruction (ACLR), preoperative rehabilitation, commonly termed prehabilitation (PreHab), has been suggested to physically and mentally prepare patients for surgery and postoperative rehabilitation. No previous systematic review has specifically evaluated the effectiveness of PreHab on postoperative outcomes. A 2017 systematic review did investigate prehabilitation, but of the included eight RCTs only two included post-operative outcomes and not all RCTs included surgery in the treatment pathway. Hypotheses: To explore the effectiveness of preoperative rehabilitation programmes (PreHab) on postoperative physical and psychological outcomes following anterior cruciate ligament reconstruction (ACLR). Methods: A systematic search was conducted from inception to November 2019. Randomised controlled trials (RCTs) published in English were included. Risk of bias was assessed using Version 2 of the Cochrane risk-of-bias tool, and the Grading of Recommendations Assessment system was used to evaluate the quality of evidence. Results: The search identified 739 potentially eligible studies, three met the inclusion criteria. All included RCTs scored ‘high’ risk of bias. PreHab in all three RCTs was an exercise programme, each varied in content (strength, control, balance and perturbation training), frequency (10 to 24 sessions) and length (3.1- to 6-weeks). Statistically significant differences (p<0.05) were reported for quadriceps strength (one RCT) and single leg hop scores (two RCTs) in favour of PreHab three months after ACLR. One RCT reported no statistically significant between-group difference for pain and function. No RCT evaluated post-operative psychological outcomes. Conclusion: Low-quality evidence suggests that PreHab that includes muscular strength, balance and perturbation training offers a small benefit to quadriceps strength and single leg hop scores three months after ACLR. There is no consensus on the optimum PreHab programme content, frequency and length; this requires future consideration including the development of PreHab programmes that consider psychosocial factors and the measurement of relevant post-operative outcomes such as psychological readiness.

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