title: Early neuromuscular electrical stimulation to improve quadriceps muscle strength after total knee arthroplasty: a randomized controlled trial.
abstract: BACKGROUND
  The recovery of quadriceps muscle force and function after total knee arthroplasty (TKA) is suboptimal, which predisposes patients to disability with increasing age.
  
  
  OBJECTIVE
  The 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.
  
  
  METHODS
  This was a prospective, longitudinal randomized controlled trial.
  
  
  METHODS
  Sixty-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.
  
  
  RESULTS
  At 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.
  
  
  CONCLUSIONS
  Treatment 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.
  
  
  CONCLUSIONS
  The 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.
authors.affiliation: Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Mail Stop C244, 13121 E 17th Ave, Room 3116, Aurora, CO 80045, USA. jennifer.stevens-lapsley@ucdenver.edu
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: Stevens-Lapsley
authors.forename: Jaclyn E
authors.initials: JE
authors.lastname: Balter
authors.forename: Pamela
authors.initials: P
authors.lastname: Wolfe
authors.forename: Donald G
authors.initials: DG
authors.lastname: Eckhoff
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Kohrt
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D019645:Arthroplasty, Replacement, Knee / Q000534:rehabilitation*; D016009:Chi-Square Distribution; D004185:Disability Evaluation; D004599:Electric Stimulation Therapy; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology; D053580:Muscle Strength / Q000502:physiology*; D010147:Pain Measurement; D011446:Prospective Studies; D052097:Quadriceps Muscle / Q000294:innervation*; D016059:Range of Motion, Articular / Q000502:physiology; D020127:Recovery of Function; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D019415:Torque; D016896:Treatment Outcome
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