None listed
Conditions
Brief summary
Knee osteoarthritis (OA) is a chronic, costly joint disease and a major contributor to functional limitations in older adults. For patients with end-staged symptomatic knee OA, a total knee replacement (TKR) is commonly indicated and although a TKR does improve selfreport (perceived) physical function and pain, patients who have undergone a TKR continue to show substantial, long-term quadriceps weakness which, in turn, is associated with activity limitations and participation restrictions. Accordingly, conservative, early interventions that effectively improve knee strength in patients with TKR are vital, and neuromuscular electrical stimulation (NMES) is one potential intervention given its ability to improve muscle activation more effectively than do voluntary exercises. Yet, little research has rigorously evaluated its benefits on muscle performance and physical function in patients with TKR. The primary aim of this randomized controlled trial (RCT) is to compare the symptomatic and biomechanical effects of NMES versus static quadriceps exercises in patients who are receiving standard acute TKR rehabilitation. Secondary aims are to assess changes in relevant musculoskeletal impairments with NMES and its cost-effectiveness.
Interventions
Standard total knee replacement (TKR) rehabilitation with neuromuscular electrical stimulation (NMES) would be delivered separately by experienced Physiotherapists. Standard TKR rehabilitation would be delivered daily from the first day post surgery till the day of discharge. One day post surgery, NMES would be delivered daily for 4 consecutive days. Standard TKR rehabilitation comprises ambulatory, knee mobility, and knee strengthening exercises. For NMES, a portable unit will be used to delive
Standard total knee replacement (TKR) rehabilitation with neuromuscular electrical stimulation (NMES) would be delivered separately by experienced Physiotherapists. Standard TKR rehabilitation would be delivered daily from the first day post surgery till the day of discharge. One day post surgery, NMES would be delivered daily for 4 consecutive days. Standard TKR rehabilitation comprises ambulatory, knee mobility, and knee strengthening exercises. For NMES, a portable unit will be used to deliver the electrical stimulation, and 2 pairs of self-adhesive surface electrodes will be placed over the vastus lateralis and vastus medialis muscles of the affected (operated) limb. The NMES unit will be set to deliver a 40-Hz biphasic current (450 microseconds pulse duration) for 5 seconds followed by a 20-second resting period (i.e., 20% duty cycle). During each 15-minute NMES session, a total of 30 repetitions will be performed, and the stimulation intensity will be adjusted to the maximal intensity tolerated by the patients.
Sponsors
Yong Hao Pua
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
50 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Patients undergoing unilateral total knee replacement due to symptomatic knee osteoarthritis
Exclusion criteria
The exclusion criteria are (i) trauma leading to TKR, (ii) rheumatoid arthritis and other systemic arthritis, (iii) back or foot/ankle pain which overshadows knee pain, (iv) skin disorder or insensitivity, (v) revision or unicondylar TKR, (vi) inability to walk unaided for short distances preoperatively, (vii) intended transfer to a step-down care facility after TKR, (viii) previous history of stroke or other neurological conditions, and (ix) unable to comply with protocol.
Outcome results
None listed