The purpose of this study is to determine whether early intervention with neuromuscular electrical stimulation (NMES) for muscle strengthening immediately after total knee arthroplasty (TKA) is more effective than voluntary exercise alone in countering changes in quadriceps muscle activation, force production, and function in older adults.
Osteoarthritis (OA) is a chronic degenerative joint disease that disables about 10% of people over the age of 60 and compromises the quality of life of more than 20 million Americans. To alleviate pain and disability associated with knee OA, over 400,000 total knee arthroplasty (TKA) are performed each year in the United States, and future projections indicate that by the year 2030, more than 750,000 TKAs will be performed per year. While TKA reliably reduces pain and improves function, the recovery of force and function to normal levels is rare, which predisposes patients to future disability with increasing age. A month after TKA, impairments in quadriceps force are predominantly due to reflex inhibition, but are also influenced, to a lesser degree, by muscle atrophy. Neuromuscular electrical stimulation (NMES) may offer a promising alternative approach to override quadriceps reflex inhibition and prevent muscle atrophy to restore normal quadriceps muscle function more effectively than voluntary exercise alone, especially when applied within the first days after surgery. The overall goal of this study is to evaluate the efficacy of NMES initiated 48hrs after TKA as an adjunct to standard rehabilitation. NMES is expected to more effectively restore normal quadriceps muscle function to produce greater quadriceps force by decreasing reflex inhibition. Patients will be randomized into one of two rehabilitation groups: 1) the standard rehabilitation group or 2) standard rehabilitation + NMES.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
66
NMES 20 minutes twice a day for 6 weeks plus standard physical therapy
Standard physical therapy for 8 weeks after surgery
UCD Physical Therapy Program
Aurora, Colorado, United States
Change From Baseline in Isometric Quadriceps Muscle Torque 3.5 Weeks Post-operatively
A HUMAC NORM electromechanical dynamometer was used to measure isometric torque generation in quadriceps muscle stabilized with 60 degrees of knee flexion.
Time frame: Baseline through 3.5 weeks
Change From Baseline in Isometric Quadriceps Muscle Torque 1-Year Post-operatively
A HUMAC NORM electromechanical dynamometer was used to measure isometric torque generation in quadriceps muscle stabilized with 60 degrees of knee flexion.
Time frame: Baseline through 1 year
Functional Performance Measure: Six-Minute Walk Test [6MWT]) at 3.5 Weeks Post-operatively
The 6MWT assesses the total distance in meters a patient walks at a self-selected pace over a 6 minute interval.
Time frame: 3.5 weeks post-operatively
Functional Performance Measure: Timed "Up & Go" Test [TUG] at 3.5 Weeks Post-operatively
The TUG assesses time in seconds to rise from an armchair, walk 3 meters, turn around, and return to sitting in the same chair without physical assistance.
Time frame: 3.5 weeks post-operatively
Functional Performance Measure: Stair-Climbing Test [SCT] at 3.5 Weeks Post-operatively
The SCT assesses the time it takes for a patient to ascend a flight of stairs, turn around, and descend the same flight of stairs.
Time frame: 3.5 weeks post-operatively
Functional Performance Measure: Six-Minute Walk Test [6MWT]) at 1 Year Post-operatively
The 6MWT assesses the total distance in meters a patient walks at a self-selected pace over a 6 minute interval.
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Time frame: 1 year post-operatively
Functional Performance Measure: Timed "Up & Go" Test [TUG] at 1 Year Post-operatively
The TUG assesses time in seconds to rise from an armchair, walk 3 meters, turn around, and return to sitting in the same chair without physical assistance.
Time frame: 1 year post-operatively
Functional Performance Measure: Stair-Climbing Test [SCT] at 1 Year Post-operatively
The SCT assesses the time it takes for a patient to ascend a flight of stairs, turn around, and descend the same flight of stairs.
Time frame: 1 year post-operatively