Comparing Conventional Physical Therapy Rehabilitation With Neuromuscular Electrical Stimulation After TKA

Abstract

Rehabilitation following total knee arthroplasty (TKA) is a costly, cumbersome, and often painful process. Physical therapy contributes to the successful outcome of TKA but can be expensive. Alternative methods of obtaining good functional results that help minimize costs are desirable. Neuromuscular electrical stimulation (NMES) is a potential option. Neuromuscular electrical stimulation has been shown to increase quadriceps muscle strength and activation following TKA. Functional scores also improve following TKA when NMES is added to conventional therapy protocols vs therapy alone. The authors hypothesized that rehabilitation managed by a physical therapist would not result in a functional advantage for patients undergoing TKA when compared with NMES and an unsupervised at-home range of motion exercise program and that patient satisfaction would not differ between the 2 groups. Seventy patients were randomized into a postoperative protocol of conventional physical therapy with a licensed therapist, including range of motion exercises and strengthening exercises, or into a program of NMES and range of motion exercises performed at home without therapist supervision. Noninferiority of the NMES program was obtained 6 weeks postoperatively (Knee Society pain/function scores, Western Ontario and McMaster Universities Osteoarthritis Index, flexion). Noninferiority was shown 6 months postoperatively for all parameters. The results suggest that rehabilitation managed by a physical therapist results in no functional advantage or difference in patient satisfaction when compared with NMES and an unsupervised at-home range of motion program. Neuromuscular electrical stimulation and unsupervised at-home range of motion exercises may provide an option for reducing the cost of the postoperative TKA recovery process without compromising quadriceps strength or patient satisfaction.

Comparison of Supervised and Unsupervised Models of Physical Therapy in Total Knee Arthroplasty: Systematic Review

“…The other three studies did not describe the random sequence generation process clearly. [11][12][13] Only one study described allocation concealment correctly. 6 The other studies did not provide a full description [11][12][13][14] resulting in unclear risk of bias.…”

“…6,[11][12][13] However, none of the studies described the exercises performed during the intervention or their intensity. (Figures 2) (Figure 3) show the results of the internal quality assessment.…”

“…Only one study described this methodological step. 6 Levine et al 11 did not detail this step, presenting unclear risk of bias. Three studies [12][13][14] did not mention this item, resulting in high risk of bias.…”

“…Two studies described this procedure well 6,13 minimizing the risk of bias. Three studies 11,12,14 described this procedure superficially, resulting in unclear risk of bias. Attrition bias is analyzed by accounting for the existence of incomplete outcomes.…”

“…Four studies compared supervised and unsupervised interventions (two groups). [11][12][13][14] Only one study investigated three physical therapy modalities: supervised individual therapy, supervised group therapy and unsupervised home therapy. 6 Two studies compared supervised outpatient care with unsupervised home care 12,14 One study compared the use of continuous passive motion (CPM) devices by an unsupervised group and a supervised group.…”