scholarly journals Effect of Neuromuscular Electrical Stimulation After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 8 ◽  
Author(s):  
Linbo Peng ◽  
Kexin Wang ◽  
Yi Zeng ◽  
Yuangang Wu ◽  
Haibo Si ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
Muscle Strength ◽  
Meta Analysis ◽  
Neuromuscular Electrical Stimulation ◽  
Quadriceps Muscle ◽  
Controlled Trials ◽  
Quadriceps Muscle Strength ◽  
Randomized Controlled ◽  
Total Knee

Background: This systematic review and meta-analysis aimed to evaluate the effect of neuromuscular electrical stimulation (NMES) on quadriceps muscle strength, pain, and function outcomes following total knee arthroplasty (TKA).Methods: PubMed/Medline, Embase, Web of Science, CENTRAL, Scopus, PsycINFO, PEDro, CINAHL, CNKI, and Wanfang were systematically searched for randomized controlled trials (RCTs) from their inception to 18 June 2021.Results: Nine RCTs that involving 691 patients were included in the meta-analysis. Our pooled analysis showed that NMES improved quadriceps muscle strength after TKA within 1 months [standardized mean difference (SMD): 0.81; 95% CI: 0.51–1.11], 1–2 months (SMD: 0.55; 95% CI: 0.13–0.97), 3–4 months (SMD: 0.42; 95% CI: 0.18–0.66), and 12–13 months (SMD: 0.46; 95% CI: 0.18–0.74), pain between 1 and 2 months [mean difference (MD): −0.62; 95% CI: −1.04 to −0.19], pain between 3 and 6 months (MD: −0.44; 95% CI: −0.74 to −0.14) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) between 3 and 4 months (MD: −0.43; 95% CI: −0.82 to −0.05), timed up and go test (TUG) within 1 month (MD: −2.23; 95% CI: −3.40 to −1.07), 3 minutes walk test between 3 and 6 months (MD: 28.35; 95% CI: 14.55–42.15), and SF-36 MCS between 3 and 6 months after TKA (MD: 4.20, 95% CI: 2.41–5.98).Conclusion: As a supplementary treatment after TKA, postoperative NMES could improve the short-term to long-term quadriceps muscle strength, mid-term pain, and mid-term function following TKA. However, many outcomes failed to achieve statistically meaningful changes and minimal clinically important difference (MCID), thus the clinical benefits remained to be confirmed.Level of Evidence: Therapeutic level I.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021265609.

scholarly journals Relationship Between Intensity of Quadriceps Muscle Neuromuscular Electrical Stimulation and Strength Recovery After Total Knee Arthroplasty

2012 ◽  
Vol 92 (9) ◽  
pp. 1187-1196 ◽  
Author(s):  
Jennifer E. Stevens-Lapsley ◽  
Jaclyn E. Balter ◽  
Pamela Wolfe ◽  
Donald G. Eckhoff ◽  
Robert S. Schwartz ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Electrical Stimulation ◽  
Muscle Strength ◽  
Muscle Fatigue ◽  
Knee Arthroplasty ◽  
Neuromuscular Electrical Stimulation ◽  
Quadriceps Muscle ◽  
Training Intensity ◽  
Quadriceps Muscle Strength ◽  
Total Knee

BackgroundNeuromuscular electrical stimulation (NMES) can facilitate the recovery of quadriceps muscle strength after total knee arthroplasty (TKA), yet the optimal intensity (dosage) of NMES and its effect on strength after TKA have yet to be determined.ObjectiveThe primary objective of this study was to determine whether the intensity of NMES application was related to the recovery of quadriceps muscle strength early after TKA. A secondary objective was to quantify quadriceps muscle fatigue and activation immediately after NMES to guide decisions about the timing of NMES during rehabilitation sessions.DesignThis study was an observational experimental investigation.MethodsData were collected from 30 people who were 50 to 85 years of age and who received NMES after TKA. These people participated in a randomized controlled trial in which they received either standard rehabilitation or standard rehabilitation plus NMES to the quadriceps muscle to mitigate strength loss. For the NMES intervention group, NMES was applied 2 times per day at the maximal tolerable intensity for 15 contractions beginning 48 hours after surgery over the first 6 weeks after TKA. Neuromuscular electrical stimulation training intensity and quadriceps muscle strength and activation were assessed before surgery and 3.5 and 6.5 weeks after TKA.ResultsAt 3.5 weeks, there was a significant association between NMES training intensity and a change in quadriceps muscle strength (R2=.68) and activation (R2=.22). At 6.5 weeks, NMES training intensity was related to a change in strength (R2=.25) but not to a change in activation (R2=.00). Furthermore, quadriceps muscle fatigue occurred during NMES sessions at 3.5 and 6.5 weeks, whereas quadriceps muscle activation did not change.LimitationsSome participants reached the maximal stimulator output during at least 1 treatment session and might have tolerated more stimulation.ConclusionsHigher NMES training intensities were associated with greater quadriceps muscle strength and activation after TKA.

scholarly journals Early Neuromuscular Electrical Stimulation to Improve Quadriceps Muscle Strength After Total Knee Arthroplasty: A Randomized Controlled Trial

2012 ◽  
Vol 92 (2) ◽  
pp. 210-226 ◽  
Author(s):  
Jennifer E. Stevens-Lapsley ◽  
Jaclyn E. Balter ◽  
Pamela Wolfe ◽  
Donald G. Eckhoff ◽  
Wendy M. Kohrt
Keyword(s):  
Total Knee Arthroplasty ◽  
Muscle Strength ◽  
Functional Performance ◽  
Controlled Trial ◽  
Neuromuscular Electrical Stimulation ◽  
Quadriceps Muscle ◽  
Self Report ◽  
Hamstring Muscle ◽  
Randomized Controlled ◽  
Total Knee

BackgroundThe recovery of quadriceps muscle force and function after total knee arthroplasty (TKA) is suboptimal, which predisposes patients to disability with increasing age.ObjectiveThe purpose of this investigation was to evaluate the efficacy of quadriceps muscle neuromuscular electrical stimulation (NMES), initiated 48 hours after TKA, as an adjunct to standard rehabilitation.DesignThis was a prospective, longitudinal randomized controlled trial.MethodsSixty-six patients, aged 50 to 85 years and planning a primary unilateral TKA, were randomly assigned to receive either standard rehabilitation (control) or standard rehabilitation plus NMES applied to the quadriceps muscle (initiated 48 hours after surgery). The NMES was applied twice per day at the maximum tolerable intensity for 15 contractions. Data for muscle strength, functional performance, and self-report measures were obtained before surgery and 3.5, 6.5, 13, 26, and 52 weeks after TKA.ResultsAt 3.5 weeks after TKA, significant improvements with NMES were found for quadriceps and hamstring muscle strength, functional performance, and knee extension active range of motion. At 52 weeks, the differences between groups were attenuated, but improvements with NMES were still significant for quadriceps and hamstring muscle strength, functional performance, and some self-report measures.LimitationsTreatment volume was not matched for both study arms; NMES was added to the standard of care treatment. Furthermore, testers were not blinded during testing, but used standardized scripts to avoid bias. Finally, some patients reached the maximum stimulator output during at least one treatment session and may have tolerated more stimulation.ConclusionsThe early addition of NMES effectively attenuated loss of quadriceps muscle strength and improved functional performance following TKA. The effects were most pronounced and clinically meaningful within the first month after surgery, but persisted through 1 year after surgery.

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