Surface electromyography‐based biofeedback and knee rehabilitation: A review of the literature

Abstract

The number of total knee arthroplasties (TKA) performed yearly is rapidly increasing. Additionally, upwards of 50% of patients who receive TKA never achieve a full functional recovery. This suggests considerable room for improvement. This need for improvement expands beyond TKA as similar effects are noted across knee injuries. Electromyography-based biofeedback (EMGBF) involves the delivery of feedback based on the activity of targeted muscle. By providing feedback contingent on changes in muscle amplitude, EMGBF may be an effective tool for strengthening quadricep muscles. This review aims to evaluate the utility of sEMGBF during physical therapy for various knee injuries. All studies were evaluated for the effectiveness of sEMGBF at improving muscle strength, range of motion, and reducing pain.Most studies reviewed found that including sEMGBF in physical therapy produced greater clinical benefits for patients than exercise alone. Further research is necessary to determine the best practice for including EMGBF in physical therapy.

Surface electromyography‐based biofeedback can facilitate recovery from total knee arthroplasty

“…The supplementary contingencies could slowly increase response amplitudes and improve muscle strength (Hof, 1997). Armshaw et al (2022) conducted a review of the archival literature in which the use of sEMG to inform a program of biofeedback (sEMG-based biofeedback or sEMGBF) was compared with standard therapeutic protocols with respect to effectiveness in improving VMO strength and other therapeutic outcomes. The authors found that the effectiveness of sEMG-based biofeedback protocols varied.…”

“…Although some studies found statistically significant improvement in specific metrics for populations with sEMGBF protocols relative to the standard therapeutic protocols, others did not. Armshaw et al (2022) identified four metrics that are commonly used to assess the effectiveness of sEMGBF protocols designed to provide postsurgical rehabilitation for the knee. These include a measure of the strength of the VMO contraction; the ROM of the joint; and a functional assessment of the time a patient takes to stand up from a sitting position, walk 3 m, turn around, walk back, and sit back down (Timed Up and Go or "TUG" test).…”

“…Upon close analysis, Armshaw et al (2022) found large differences in how sEMGBF protocols were designed and implemented across the studies reviewed. These differences included factors that are considered important from a behavioral perspective.…”

“…Concerning the strength of the VMO, for example, Armshaw et al (2022) observed that six studies found statistically significant improvement with sEMGBF relative to the standard protocol but six studies did not. Similarly, for ROM and the TUG test, four studies found statistically significant improvement with sEMGBF relative to the standard protocols but five studies did not.…”

“…These differences included factors that are considered important from a behavioral perspective. For example, studies differed in whether baseline data were collected, whether these measures were used to inform the criteria established for feedback, and whether muscle strength was repeatedly assessed to adjust criteria for reinforcement (see Table 7 in Armshaw et al, 2022). In general, the review found that studies that included baselines, collected repeated measures of the VMO strength, and used that information to adjust criteria produced better outcomes.…”