Rebecca J.

Stevens
Modality Abstract #2

PTA 102

Stevens-Lapsley J, Balter J, Kohrt W, et al. Relationship Between Intensity of Quadriceps Muscle

Neuromuscular Electrical Stimulation and Strength Recovery After Total Knee Arthroplasty.
Physical Therapy. September 2012; 92(9):1187-1196.

Purpose:

The purpose of this study was to determine the effectiveness of using

neuromuscular electrical stimulation (NMES) after total knee arthroplasty (TKA).
The study was primarily focused on using NMES in addition to standard TKA
rehabilitation beginning 48 hours after the surgery. With the prevalence of a TKA
as a treatment for osteoarthritis, this studys aim is to share the benefits of NMES
in addressing quadriceps muscle weakness post-surgery.

Method:

The study utilized a randomized, controlled, parallel group intervention method

with 2 intervention groups by sex and age. Each group was divided further into
random blocks of 4, 6, or 8. The 66 participants who qualified had undergone a
primary unilateral tricompartmental cemented TKA with a medial parapatellar
surgical approach under the care of 1 of 3 specific surgeons at the University of
Colorado Hospital. Participants were between 50 to 85 years old without
uncontrolled hypertension or diabetes, a BMI lower than 35 kg/m2, neurological
impairments, contralateral OA, or other unstable lower-extremity orthopedic
conditions. All participants received the same standard TKA rehabilitation as
inpatients, as well as 6 home treatments following discharge. The NMES was
performed using a portable Empi 300PV stimulator, which is practical for both
clinical and home use and set to deliver a biphasic current at 50 pps for 15
seconds and off for 45 seconds.

Results:

Results were measured using the Timed Up & Go test (TUG), Stair-Climbing
Test (SCT), the Six-Minute Walk Test (SCT), 11-point verbal numeric pain rating
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Rebecca J. Stevens
Modality Abstract #2

PTA 102

scale, ROM, goniometry measurements, and health status questionnaires. At

week 3.5, the NMES group had overall higher results in all areas with the
exception of the SF-36 and WOMAC scores, which had no difference. 52 weeks
post op, both groups had made great improvements with the NMES group
maintaining slightly higher results. There was over roughly 80% participant
adherence throughout the entire study.
Conclusion: The addition of NMES to the standard TKA rehabilitation plan is effective in
lessening the loss of strength in the quadriceps muscles. The study shows the
NMES participants were most dramatically affected during the first month of the
NMES included program. However, limitations in the study, including using
various types of muscles contractions during the NMES treatment, patients with
higher BMIs and limiting the higher intensities of the NMES may have created
different results. The authors consider that further study into NMES and other
post-operative rehabilitation programs should be researched further, as the current
depth of study is somewhat limited.
Opinion:

I found this study to be interesting in that the applications could go beyond TKA
and be applied to other knee surgeries which create a loss in quadriceps strength.
Perhaps, in addition to creating a more in depth study as the authors suggest, other
studies could utilize participants who have undergone Distal Tibial Tuberosity
Realignment, a menisectomy, or other types of TKAs and knee surgeries. I would
also be curious on the use of NMES on CVA patients or other neurological type
conditions. I felt this study was successful not only for the authors interest in
widening the pool of research of quadriceps strengthening techniques.

Abstracted by:

Rebecca J. Stevens; Class of 2014

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