Effects of preoperative neuromuscular electrical stimulation on quadriceps strength and functional recovery in total knee arthroplasty. A pilot study

Abstract

BackgroundSupervised preoperative muscle strengthening programmes (prehabilitation) can improve recovery after total joint arthroplasty but are considered resource intensive. Neuromuscular electrical stimulation (NMES) has been shown to improve quadriceps femoris muscle (QFM) strength and clinical function in subjects with knee osteoarthritis (OA) however it has not been previously investigated as a prehabilitation modality.MethodsThis pilot study assessed the compliance of a home-based, NMES prehabilitation programme in patients undergoing total knee arthroplasty (TKA). We evaluated its effect on preoperative and postoperative isometric quadriceps femoris muscle (QFM) strength, QFM cross-sectional area (CSA) and clinical function (subjective and objective). Seventeen subjects were recruited with 14 completing the study (NMES group n = 9; Control group n = 5).ResultsOverall compliance with the programme was excellent (99%). Preoperative QFM strength increased by 28% (p > 0.05) with associated gains in walk, stair-climb and chair-rise times (p < 0.05). Early postoperative strength loss (approximately 50%) was similar in both groups. Only the NMES group demonstrated significant strength (53.3%, p = 0.011) and functional recovery (p < 0.05) from 6 to 12 weeks post-TKA. QFM CSA decreased by 4% in the NMES group compared to a reduction of 12% in the control group (P > 0.05) at 12 weeks postoperatively compared to baseline. There were only limited associations found between objective and subjective functional outcome instruments.ConclusionsThis pilot study has shown that preoperative NMES may improve recovery of quadriceps muscle strength and expedite a return to normal activities in patients undergoing TKA for OA. Recommendations for appropriate outcome instruments in future studies of prehabilitation in TKA have been provided.

Prehabilitation Improves Physical Function of Individuals with Severe Disability from Hip or Knee Osteoarthritis

“…Ré sultats : Au total, 28 individus (16 femmes, 12 hommes) avec un â ge moyen (é cart-type : ET) de 67 (10) ans et un IMC moyen de 33 (8) kg/m 2 en attente d'une arthroplastie (10 hanches, 18 genoux) ont participé au programme de pré -ré adaptation d'une duré e moyenne de 9 (6) semaines. Suivant l'intervention, des changements significatifs ont é té observé s en termes d'incapacité s fonctionnelles mesuré par l'É FMI (changement moyen de 7,6; IC 95%, 1,7-13,5; p ¼ 0,013), au test de marche à vitesse libre (changement moyen de 0,17 m/s; IC 95%: 0,07-0,26; p ¼ 0,001), au test TUG (changement moyen de 4,2 s; IC 95%, 2,0-6,4; p < 0,001) et au test chronomé tré des escaliers (changement moyen de 3,8 s [ET : 14,6]; p ¼ 0,005). Conclusion : Cette é tude pré sente des é vidences pré liminaires qu'un programme de pré -ré adaptation, chez des patients souffrant d'arthrose, en attente d'une arthroplastie du genou ou de la hanche, peut amé liorer la fonction physique mê me chez les patients les plus sé vè rement atteints.…”

“…Although some studies have reported no benefit of such pre-surgery interventions, 9-11 others have demonstrated that prehabilitation programmes for people awaiting TJA have positive effects on patients' health status and may also lead to better postoperative outcomes. [12][13][14][15] The reasons for these differences remain unclear, but the type of exercise programme, and whether it is standardized or personally tailored to address patients' specific needs, may influence the outcomes. Other factors, such as the intensity and duration of the programme and exercise supervision or feedback given, may also be important in explaining these discrepancies in treatment effectiveness.…”

Exercise training combined with electromyostimulation in the rehabilitation of patients with chronic heart failure: A randomized trial

“…It can be presumed that using the combination of both types of exercise may lead to cumulative adaptation in the given muscle, as well as to higher overall efficiency. This presumption is confirmed by a few studies on the combination of EMS and VMC, in the area of muscle rehabilitation and regeneration after surgery 15,16 . From this perspective, achieving a higher training benefit for CHF patients would be of great importance, but to date the effects of ET + EMS combination in these patients have not been reported.…”

Rehabilitation and Physical Therapy before and after Total Knee Arthroplasty: A Literature Review and Unanswered Questions

“…To our knowledge, the first study that used NMES as a prerehabilitation modality was published in 2010: patients treated with NMES increased pre-operative quadriceps femoris muscle strength by 28% and had a faster functional recovery following TKA [21].…”

“…Furthermore, NMES may also reduce the extent of post-operative muscle atrophy [18][19][20][21][22][23][24].…”