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DOI: 10.1055/s-0034-1367022
Efficacy of Neuromuscular Electrical Stimulation on Quadriceps Femoris Muscle in Patients with Knee Osteoarthritis
Wirksamkeit neuromuskulärer Stimulation des M. quadriceps femoris bei Patienten mit Osteoarthritis des KniesPublication History
received 21 May 2013
accepted 14 January 2014
Publication Date:
28 April 2014 (online)
Abstract
Objectives:
Neuromuscular electrical stimulation (NMES) has been used in rehabilitation protocols for patients suffering from muscle weakness. The purpose of the present study was to assess the effect of NMES on isometric quadriceps femoris (QF) muscle strength and functional outcomes in patients with knee osteoarthritis (OA).
Methods:
A total of 30 patients of OA with a mean age of 61.17±4.3 years were participated in the study. Eligible subjects were randomly assigned in to one of the 2 groups, group A and B (n=15) in each group. Patients in group-B were undergone NMES to the QF along with conventional physiotherapeutic regime for 3 weeks whereas, group-A was given only conventional physiotherapeutic regime. The study outcomes such as isometric strength at 20, 40 and 60° of knee flexion, mean isometric muscle strength and functional outcomes by WOMAC index score were measured at baseline, 9 days and end of 3 weeks of post intervention.
Results:
Comparison of quadriceps muscle strength at 20,40 and 60° and its mean in knee flexion and WOMAC index score were within group-A were non-significant (p>0.05) whereas, in group-B (p<0.05). The quadriceps muscle strength at 20° between groups at base line, 9th day and post test at 21st day showed significant improvement in NMES group (p<0.05). Similar difference was repeated with NMES group at 40 and 60° and WOMAC functional index score also.
Conclusions:
Study result indicates that NMES is effective in improving muscle strength thereby improving the functional activities of patients with knee OA. NMES along with conventional physiotherapeutic approach is a better choice for the management of knee OA.
Zusammenfassung
Zielstellung:
Neuromuskuläre elektrische Stimulation (NMES) wurde im Rahmen von Rehabilitationsprotokollen zur Therapie von Patienten mit Muskelschwäche eingesetzt. Ziel der vorliegenden Studie war die Untersuchung des Effektes von NMES auf die isometrische Muskelkraft des Quadriceps femoris (QF) sowie das funktionelle Outcome bei Patienten mit Osteoarthritis (OA) des Kniegelenks.
Methoden:
Insgesamt 30 unter OA leidende Patienten mit einem Durchschnittsalter von 61,17±4,3 Jahren nahmen an der Studie teil. Geeignete Teilnehmer wurden randomisiert und einer von 2 Gruppen, A oder B (n=25), zugewiesen. Die Patienten in Gruppe B erhielten NMES des QF im Verbindung mit konventioneller Physiotherapie für einen Zeitraum von 3 Wochen, während Gruppe A lediglich mit konventioneller Physiotherapie behandelt wurde. Die Erhebung der Messparameter wie isometrische Kraft bei 20, 40 und 60° Knieflexion, die durchschnittliche isometrische Muskelkraft und das funktionelle Assessment (WOMAC) erfolgte als Baseline, nach 9 Tagen und 3 Wochen nach Intervention.
Ergebnisse:
Der Vergleich der Quadrizeps-Muskelkraft bei 20, 40 sowie 60° und die mittlere Kraft bei Knieflexion sowie der WOMAC-Score in Gruppe A waren nicht signifikant (p>0,05) im Gegensatz zu den Werten in Gruppe B (p<0,05). Die Muskelkraft des Quadriceps bei 20°-Flexion zu Beginn, am 9. Tag sowie nach der Intervention am 21. Tag zeigten signifikante Verbesserungen innerhalb der NMES-Gruppe (p<0,05). Gleiche Ergebnisse der NMES-Gruppe konnten bei 40 und 60° sowie beim WOMAC Index Score nachgewiesen werden.
Schlussfolgerung:
Die Studienergebnisse weisen auf eine Wirksamkeit von NMES hinsichtlich der Verbesserung der Muskelkraft hin mit dem Ergebnis einer Verbesserung der funktionellen Aktivitäten von Patienten mit Osteoarthritis des Knies. Zusammen mit konventioneller Physiotherapie bildet NMES eine bessere Option hinsichtlich der Therapie von Knie-OA.
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References
- 1 Bennell KL, Hinman RS. A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. J Sci Med Sport 2011; 14: 4-9
- 2 Brooks PM. Impact of osteoarthritis on individuals and society: how much disability? Social consequences and health economic implications. Curr Opin Rheumatol 2002; 14: 573-577
- 3 Chantraine A, Baribeault A, Uebelhart D et al. Shoulder pain and dysfunction in hemiplegia: effects of functional electrical stimulation. Arch Phys Med Rehabil 1999; 80: 328-331
- 4 Devos-Comby L, Cronan T, Roesch SC. Do exercise and self-management interventions benefit patients with osteoarthritis of the knee? A metaanalytic review. J Rheumatol 2006; 33: 744-756
- 5 Durmus D, Alayli G, Canturk F. Effects of quadriceps electrical stimulation program on clinical parameters in the patients with knee osteoarthritis. Clin Rheumatol 2007; 26: 674-678
- 6 Felson DT, Zhang Y. An update on the epidemiology of knee and hip osteoarthritis with a view to prevention. Arthritis Rheum 1998; 41: 1343-1355
- 7 Gabyzon ME, Rozen N, Laufer Y. Does neuromuscular electrical stimulation enhance the effectiveness of an exercise programme in subjects with knee osteoarthritis? A randomized controlled trial. Clin Rehabil 2013; 27: 246-257
- 8 Giombini A, Di Cesare A, Di Cesare M et al. Localized hyperthermia induced by microwave diathermy in osteoarthritis of the knee: a randomized placebo-controlled double-blind clinical trial. Knee Surg Sports Traumatol Arthrosc 2011; 19: 980-987
- 9 Gryzlo SM, Patek RM, Pink M et al. Electromyographic analysis of knee rehabilitation exercises. Journal of Orthopaedic and Sports Physical Therapy 1994; 20: 36-43
- 10 Hartsell HD, Kramer JF. A comparison of the effects of electrode placement, muscle tension, and isometric torque of the knee extensors. J Orthop Sports Phys Ther 1992; 15: 168-174
- 11 Hurley MV. Muscle dysfunction and effective rehabilitation of knee osteoarthritis: what we know and what we need to find out. Arthritis Rheum 2003; 49: 444-452
- 12 Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957; 16: 494-502
- 13 Maffiuletti NA, Zory R, Miotti D et al. Neuromuscular adaptations to electrostimulation resistance training. Am J Phys Med Rehabil 2006; 85: 167-175
- 14 Miller M, Downham D, Lexell J. Superimposed single impulse and pulse train electrical stimulation: a quantitative assessment during submaximal isometric knee extension in young, healthy men. Muscle Nerve 1999; 22: 1038-1046
- 15 Monaghan B, Caulfield B, O’Mathuna DP. Surface neuromuscular electrical stimulation for quadriceps strengthening pre and post total knee replacement. Cochrane Database Syst Rev 2010; Art. No.: CD007177
- 16 O’Reilly SC, Jones A, Muir KR et al. Quadriceps weakness in knee osteoarthritis: the effect on pain and disability. Ann Rheum Dis 1998; 57: 588-594
- 17 Palmieri-Smith RM, Thomas AC, Karvonen-Gutierrez C et al. A clinical trial of neuromuscular electrical stimulation in improving quadriceps muscle strength and activation among women with mild and moderate osteoarthritis. Phys Ther 2010; 90: 1441-1452
- 18 Pekindil Y, Sarikaya A, Birtane M et al. 99mTc-sestamibi muscle scintigraphy to assess the response to neuromuscular electrical stimulation of normal quadriceps femoris muscle. Ann Nucl Med 2001; 15: 397-401
- 19 Puett DW, Griffin MR. Published trials of nonmedicinal and noninvasive therapies for hip and knee osteoarthritis. Annals of Internal Medicine 1994; 121: 133-140
- 20 Sheila C, O’Reilly Jones A, Muir KR. et al. Quadriceps weakness in knee osteoarthritis: the effect on pain and disability. Ann Rheum Dis 1998; 57: 588-594
- 21 Snyder-Mackler L, Delitto A, Bailey SL et al. Strength of the quadriceps femoris muscle and functional recovery after reconstruction of the anterior cruciate ligament. A prospective, randomized clinical trial of electrical stimulation. J Bone Joint Surg Am 1995; 77: 1166-1173
- 22 Suetta C, Aagaard P, Magnusson SP et al. Muscle size, neuromuscular activation, and rapid force characteristics in elderly men and women: effects of unilateral long-term disuse due to hip-osteoarthritis. J Appl Physiol 2007; 102: 942-948
- 23 Walls RJ, McHugh G, O’Gorman DJ et al. Effects of preoperative neuromuscular electrical stimulation on quadriceps strength and functional recovery in total knee arthroplasty. A pilot study. BMC Musculoskelet Disord 2010; 11: 119
- 24 World Health Organization Bone and Joint Decade’s Musculoskeletal Portal. http://www.boneandjointdecade.org 2012 Accessed 10 Sept 2012
- 25 Zhang Y, Jordan J. Epidemiology of osteoarthritis. Clin Geriatr Med 2010; 26: 355-369