1
|
Di Pietro A, Cameron M, Campana V, Leyes L, Zalazar Cinat JAI, Lochala C, Johnson CZ, Hilldebrand A, Loyo M. Efficacy of adding selective electrical muscle stimulation to usual physical therapy for Bell's palsy: immediate and six-month outcomes. Eur J Transl Myol 2023; 33:11630. [PMID: 37877154 PMCID: PMC10811644 DOI: 10.4081/ejtm.2023.11630] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/28/2023] [Indexed: 10/26/2023] Open
Abstract
Bell's palsy is the most common cause of facial paralysis, affecting one in every 60 people in their lifetime. Transcutaneously applied selective electrical muscle stimulation could potentially accelerate recovery from Bell's palsy but this intervention remains controversial. Studies have shown benefit, but concerns for lack of efficacy and potential for worsening synkinesis remain. We performed a prospective controlled trial comparing outcomes at initial recovery and six months later with selective electrical muscle stimulation and usual physical therapy versus usual physical therapy alone in adults with acute Bell's palsy. Outcomes were facial function assessed with the House Brackman and eFACE scales. Outcomes were evaluated at discharge and six months after discharge. Discharge occurred when participants were judged to be fully recovered by their treating therapist and supervisor. 38 adults participated in the study. Participants in the electrical stimulation group achieved maximal recovery twice as fast as the control group (2.5 weeks versus 5.2 weeks) with no significant differences in facial function or synkinesis between groups at any time point. This study is the first human trial of electrical stimulation in Bell's palsy to follow patients 6 months from recovery and supports that selective electrical muscle stimulation accelerates recovery and does not increase synkinesis.
Collapse
Affiliation(s)
| | - Michelle Cameron
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA; VA Portland Health Care System.
| | - Vilma Campana
- Department of Biomedical Physics, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba.
| | - Laura Leyes
- Department of Kinesiology and Physical Therapy, Universidad Nacional del Nordeste, Corrientes.
| | | | - Carly Lochala
- Department of Rehabilitation, Oregon Health & Science University, Portland, OR, USA; Division of Biokinesiology & Physical Therapy, University of Southern California.
| | - Christopher Z Johnson
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University, Portland, OR.
| | - Andrea Hilldebrand
- Biostatistics and Design Program, Oregon Health & Science University, Portland, OR, USA; Portland State University School of Public Health, Portland, OR.
| | - Myriam Loyo
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University, Portland, OR.
| |
Collapse
|
2
|
A Novel Mobile App-based Neuromuscular Electrical Stimulation Therapy for the Management of Knee Osteoarthritis: Results From an Extension Study of a Randomized, Double-blind, Sham-controlled, Multicenter Trial. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202209000-00004. [PMID: 36094457 PMCID: PMC9470129 DOI: 10.5435/jaaosglobal-d-22-00115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 04/30/2022] [Indexed: 11/22/2022]
Abstract
Mobile app-based neuromuscular electrical stimulation (NMES) is a promising treatment of knee osteoarthritis as previously demonstrated in a 12-week, randomized, double-blind, sham-controlled, multicenter trial (parent study).
Collapse
|
3
|
Labanca L, Bonsanto F, Raffa D, Orlandi Magli A, Benedetti MG. Does adding neuromuscular electrical stimulation to rehabilitation following total knee arthroplasty lead to a better quadriceps muscle strength recovery? A systematic review. Int J Rehabil Res 2022; 45:118-125. [PMID: 35256573 DOI: 10.1097/mrr.0000000000000525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Patients undergoing total knee arthroplasty (TKA) show postsurgical quadriceps weakness. Neuromuscular electrical stimulation (NMES) has been shown to be an effective treatment for muscle strength recovery in a number of orthopaedic conditions. The aim of this review is to investigate whether adding NMES to TKA rehabilitation leads to a better quadriceps strength recovery in comparison with standardized rehabilitation. A second aim is to investigate which are the most commonly used NMES pulse settings and their effectiveness. A systematic review of literature was conducted on PubMed, Cochrane, Scopus and Web-of-Science. Intervention studies evaluating the effects of a rehabilitation intervention based on quadriceps NMES in patients undergoing TKA were retrieved. Methodological quality was assessed using the risk of bias-2 Cochrane tool. Features of NMES rehabilitation and technical data on NMES settings were extracted from the studies. Four studies met the inclusion criteria. Due to the limited number and the heterogeneity of the selected studies, it was not appropriate to carry out a meta-analysis. All the studies reported higher quadriceps strength in patients undergoing quadriceps NMES, particularly early after TKA. The addition of NMES or traditional strength training shows similar long-term effects. Short duration and low-intensity NMES have limited effects on quadriceps strength. Heterogeneity was found on NMES methodologies and pulse settings. In conclusion, NMES is effective for quadriceps strength recovery following TKA. NMES intensity and duration are essential for good NMES outcomes on quadriceps strength. Further studies on NMES methodologies, pulse features and settings are required to address the gaps in knowledge on NMES following TKA.
Collapse
Affiliation(s)
- Luciana Labanca
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Fabio Bonsanto
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli
| | - Debora Raffa
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli
| | | | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| |
Collapse
|
4
|
Peng L, Wang K, Zeng Y, Wu Y, Si H, Shen B. Effect of Neuromuscular Electrical Stimulation After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Med (Lausanne) 2021; 8:779019. [PMID: 34926522 PMCID: PMC8677678 DOI: 10.3389/fmed.2021.779019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/08/2021] [Indexed: 02/05/2023] Open
Abstract
Background: This systematic review and meta-analysis aimed to evaluate the effect of neuromuscular electrical stimulation (NMES) on quadriceps muscle strength, pain, and function outcomes following total knee arthroplasty (TKA). Methods: PubMed/Medline, Embase, Web of Science, CENTRAL, Scopus, PsycINFO, PEDro, CINAHL, CNKI, and Wanfang were systematically searched for randomized controlled trials (RCTs) from their inception to 18 June 2021. Results: Nine RCTs that involving 691 patients were included in the meta-analysis. Our pooled analysis showed that NMES improved quadriceps muscle strength after TKA within 1 months [standardized mean difference (SMD): 0.81; 95% CI: 0.51–1.11], 1–2 months (SMD: 0.55; 95% CI: 0.13–0.97), 3–4 months (SMD: 0.42; 95% CI: 0.18–0.66), and 12–13 months (SMD: 0.46; 95% CI: 0.18–0.74), pain between 1 and 2 months [mean difference (MD): −0.62; 95% CI: −1.04 to −0.19], pain between 3 and 6 months (MD: −0.44; 95% CI: −0.74 to −0.14) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) between 3 and 4 months (MD: −0.43; 95% CI: −0.82 to −0.05), timed up and go test (TUG) within 1 month (MD: −2.23; 95% CI: −3.40 to −1.07), 3 minutes walk test between 3 and 6 months (MD: 28.35; 95% CI: 14.55–42.15), and SF-36 MCS between 3 and 6 months after TKA (MD: 4.20, 95% CI: 2.41–5.98). Conclusion: As a supplementary treatment after TKA, postoperative NMES could improve the short-term to long-term quadriceps muscle strength, mid-term pain, and mid-term function following TKA. However, many outcomes failed to achieve statistically meaningful changes and minimal clinically important difference (MCID), thus the clinical benefits remained to be confirmed. Level of Evidence: Therapeutic level I. Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021265609.
Collapse
Affiliation(s)
- Linbo Peng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Kexin Wang
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Zeng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yuangang Wu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Haibo Si
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Shen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
5
|
Abe G, Oyama H, Liao Z, Honda K, Yashima K, Asao A, Izumi SI. Difference in Pain and Discomfort of Comparable Wrist Movements Induced by Magnetic or Electrical Stimulation for Peripheral Nerves in the Dorsal Forearm. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2020; 13:439-447. [PMID: 33376417 PMCID: PMC7755354 DOI: 10.2147/mder.s271258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/29/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Both repetitive peripheral magnetic stimulation (rPMS) and transcutaneous electrical current stimulation (TES) could elicit the limb movements; it is still unclear how subjective sensation is changed according to the amount of limb movements. We investigated the pain and discomfort induced by newly developed rPMS and TES of peripheral nerves in the dorsal forearm. Methods The subjects were 12 healthy adults. The stimulus site was the right dorsal forearm; thus, when stimulated, wrist dorsiflexion was induced. The rPMS was delivered by the new stimulator, Pathleader at 10 stimulus intensity levels, and TES intensity was in 1-mA increments. The duration of each stimulation was 2 s. The analysis parameters were subjective pain and discomfort, measured by a numerical rating scale. The rating scale at corresponding levels of integrated range of movement (iROM) induced by rPMS or TES was compared. The subjective values were analyzed by two-way repeated measures ANOVA with the stimulus conditions (rPMS, TES) and the seven levels of iROM (20-140 ºs). Results In the rPMS experiments, stimuli were administered to all subjects at all stimulus intensities. In the TES experiments, none of the subjects dropped out between 1 and 16 mA, but there were dropouts at each of the intensities as follows: 1 subject at 17 mA, 20 mA, 22 mA, 23 mA, 27 mA, 29 mA and 2 subjects at 21 mA, 24 mA, 26 mA. The main effects of the stimulus conditions and iROM were significant for pain and discomfort. Post hoc analysis demonstrated that pain and discomfort in rPMS were significantly lower compared to TES when the iROM was above 60 ºs and 80 ºs, respectively. Conclusion New rPMS stimulator, Pathleader, caused less pain and discomfort than TES, but this was only evident when comparatively large joint movements occurred.
Collapse
Affiliation(s)
- Genji Abe
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Rehabilitation, Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen University, Sendai, Miyagi, Japan
| | - Hideki Oyama
- Department of Physical Medicine and Rehabilitation, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Miyagi, Japan
| | - Zhenyi Liao
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Keita Honda
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | | | - Akihiko Asao
- Department of Occupational Therapy, Niigata University of Health and Welfare, Niigata, Japan
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Physical Medicine and Rehabilitation, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Miyagi, Japan
| |
Collapse
|
6
|
Riedler DC, Zsoldos RR, Robel M, Jobst ID, Licka TF. Movement Caused by Electrical Stimulation of the Lumbosacral Region in Standing Horses. J Equine Vet Sci 2020; 91:103116. [PMID: 32684261 DOI: 10.1016/j.jevs.2020.103116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/12/2020] [Accepted: 05/04/2020] [Indexed: 11/29/2022]
Abstract
Electrical stimulation is commonly used as a modality for physical therapy in human and veterinary medicine. However, studies measuring the movement generated by electrical stimulation in horses are rare. The present study therefore evaluates the range of movement provoked by a commercially available physical therapy unit (FES310) and contrasts it with the movement generated by manually induced pelvic inclination (back rounding). Ten horses were tested on three measurement days over one week. Electrical stimulation was applied via a back treatment pad (belonging to the FES310 system) containing six electrodes (three on either side of the spine) placed over the lumbosacral region. This system produced a pulsed, biphasic electrical stimulation in a rectangular waveform which was gradually increased to a maximum of 10 volts. Before and after electrical stimulation testing, manual pelvic inclination was achieved by pressure on two points lateral to the root of the tail. Muscle tone and lameness were evaluated before and after treatments. Skinfold thickness, body condition score, and body mass were measured to detect possible confounding factors. Using kinematics, the angle ranges during movement of ten three-dimensional angles of the trunk, the pelvis, and the hind limbs were further analyzed. Movement was produced with manual stimulation in every tested individual on all measurement days and with electrical stimulation on at least one measurement day. The electrical stimulation led to significantly (P < .05) smaller angle ranges which were 15 %-57 % of the median of the manually stimulated movement. Strong positive correlations between angle ranges of the electrically generated movement were found for the hind limbs implicating their involvement in the movement created. Correlations between skinfold thickness, body condition score, and body mass with the angle ranges were weak and not significant. Before and after electrical and manual stimulation, muscle tone and lameness were similar. In the present study, both electrical and manual stimulation were proven to produce significant trunk and hind limb movement. Within this study's electrical stimulation treatment protocol, the movement generated by electrical stimulation was significantly less than the movement caused by manual pelvic inclination. However, electrical stimulation could easily be applied over a longer period and in a higher frequency than it would be possible for manual pelvic inclination. This treatment shows potential for stabilization and or mobilization of the lumbosacral region, although its efficiency as a therapeutic tool and its effect on specific orthopedic problems and is to be evaluated in further research.
Collapse
Affiliation(s)
- Daniela C Riedler
- University Clinic for Horses, Department of Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| | - Rebeka R Zsoldos
- School of Agriculture and Food Sciences, The University of Queensland, Gatton, Queensland, Australia
| | - Matthias Robel
- University Clinic for Horses, Department of Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| | - Isabelle D Jobst
- University Clinic for Horses, Department of Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| | - Theresia F Licka
- University Clinic for Horses, Department of Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria; Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush Campus, Midlothian, Scotland, United Kingdom.
| |
Collapse
|
7
|
Loyo M, McReynold M, Mace JC, Cameron M. Protocol for randomized controlled trial of electric stimulation with high-volt twin peak versus placebo for facial functional recovery from acute Bell's palsy in patients with poor prognostic factors. J Rehabil Assist Technol Eng 2020; 7:2055668320964142. [PMID: 33354350 PMCID: PMC7734495 DOI: 10.1177/2055668320964142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/26/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Electric stimulation (ES) can prevent muscle atrophy and promote tissue healing and therefore may help prevent sequelae of Bell's palsy but due to lack of high-quality studies, the effectiveness of ES in Bell's palsy remains controversial. Here we describe a protocol to evaluate the effects of monophasic high volt ES in patients with Bell's palsy and poor prognosis for recovery. RESULTS This is a protocol for a prospective, double-blinded, randomized, placebo-controlled study. Participants include adults with acute Bell's palsy with poor prognosis for full recovery due to complete paralysis or being over age 60. ES will be a monophasic, high-volt pulsed waveform, 100μsec pulse duration, 35 hertz, motor-level intensity. Follow up will be at months 1, 2, 3 and 6. The primary outcome will be the proportion of patients with complete recovery using the eFACES tool. Secondary outcomes include patient reported quality of life measured by FaCE and the synkinesis assessment questionnaires, objective photographs, time to complete recovery, adverse effects, and tolerability. CONCLUSION This protocol has the potential to provide high quality evidence regarding the effects, up to 6 months after onset, of pulsed monophasic high-volt ES for patients with acute Bell's palsy and poor prognosis for complete recovery.
Collapse
Affiliation(s)
- Myriam Loyo
- Department of Otolaryngology – Head and Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Margaret McReynold
- Department of Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Jess C Mace
- Department of Otolaryngology – Head and Neck Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Michelle Cameron
- Department of Neurology, Oregon Health & Science University, Oregon Health & Science University, Portland, OR, USA
- VA Portland Health Care System, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
8
|
Khoziainova SS, Kovlen DV, Ponomarenko GN, Abuseva GR, Adkhamov BM, Ishchuk VN, Karpova TN, Kondrina EF, Konoplyankin IV, Podberezkina LA, Tolmachev SV. [Physical therapy in the rehabilitation of patients after endoprosthetic replacement of major joints in the lower extremities: a scientometric analysis of evidence-based studies]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOĬ FIZICHESKOĬ KULTURY 2019; 96:22-31. [PMID: 31880761 DOI: 10.17116/kurort20199606122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND In recent decades, the volume of high-tech medical care in the field of orthopedics and traumatology, including endoprosthetic replacement of major joints (MJs) (the hip joint and/or the knee joint) in the lower extremities (LE) (LEMJ), has substantially increased. In this connection, there are an increasing number of patients in need of medical rehabilitation, to solve the problems of which needs the effective physical and rehabilitation medicine (PRM) techniques proven during researches to be introduced into practice. OBJECTIVE To analyze evidence-based studies containing sound data on the use of PRM technologies in the rehabilitation of patients after endoprosthetic replacement of LEMJs, to identify the most effective PRM technologies and to formulate recommendations for their use for practitioners, which are based on the evidence obtained during the analysis. MATERIAL AND METHODS The paper is based on the scientometric analysis of 241 studies conducted in 2000 to 2018, which were devoted to the use of physical exercises and PRM technologies in the rehabilitation of patients after endoprosthetic replacement of LEMJs. RESULTS Over the past decade, there has been a tangible rise in the number of studies on endoprosthetic replacement of LEMJs. Some of the most studied PRM technologies having the proven effect are physical exercises in combination with neuromuscular electrical stimulation, kinesiotherapy, cryotherapy, and pressure therapy that is effective in preventing thromboembolism after surgery. CONCLUSION The use of PRM technologies in the rehabilitation of patients after endoprosthetic replacement of LEMJs should be based on the results of high-quality randomized controlled clinical trials, which serve as the basis for the development of clinical recommendations. The process of analyzing the data of studies should be regular.
Collapse
Affiliation(s)
- S S Khoziainova
- S.M. Kirov Military Medical Academy, Ministry of Defense of Russia, St. Petersburg, Russia
| | - D V Kovlen
- S.M. Kirov Military Medical Academy, Ministry of Defense of Russia, St. Petersburg, Russia
| | - G N Ponomarenko
- S.M. Kirov Military Medical Academy, Ministry of Defense of Russia, St. Petersburg, Russia; G.A. Albrekht Federal Research Center for Rehabilitation of the Disabled, Ministry of Labor of Russia, St. Petersburg, Russia
| | - G R Abuseva
- S.M. Kirov Military Medical Academy, Ministry of Defense of Russia, St. Petersburg, Russia
| | - B M Adkhamov
- S.M. Kirov Military Medical Academy, Ministry of Defense of Russia, St. Petersburg, Russia
| | - V N Ishchuk
- S.M. Kirov Military Medical Academy, Ministry of Defense of Russia, St. Petersburg, Russia
| | - T N Karpova
- S.M. Kirov Military Medical Academy, Ministry of Defense of Russia, St. Petersburg, Russia
| | - E F Kondrina
- S.M. Kirov Military Medical Academy, Ministry of Defense of Russia, St. Petersburg, Russia
| | - I V Konoplyankin
- S.M. Kirov Military Medical Academy, Ministry of Defense of Russia, St. Petersburg, Russia
| | - L A Podberezkina
- S.M. Kirov Military Medical Academy, Ministry of Defense of Russia, St. Petersburg, Russia
| | - S V Tolmachev
- S.M. Kirov Military Medical Academy, Ministry of Defense of Russia, St. Petersburg, Russia
| |
Collapse
|
9
|
Sultan AA, Samuel LT, Bhave A. Utilization and outcomes of neuromuscular electric stimulation in patients with knee osteoarthritis: a retrospective analysis. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S246. [PMID: 31728370 DOI: 10.21037/atm.2019.08.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Knee osteoarthritis (OA) is a chronic debilitating condition that is estimated to affect approximately 12% of the current adult population in the United States, and is associated with severe pain and disability. Among these patients, quadriceps muscle atrophy and concomitant weakness are frequent findings that contribute significantly to the burden of this disease. One emerging method of quadriceps muscle strengthening and rehabilitation in knee OA patients is the use of neuromuscular electrical stimulation therapy (NMES). Among the currently available systems for NMES therapy are the mobile health (mHealth) platforms allowing clinicians to monitor patient compliance and utilization trends in addition to capturing certain clinical outcome points. The aim of this study was to analyze data collected by a commercially available mobile-app controlled NMES platform and to examine: (I) utilization trends, (II) range-of-motion (ROM) changes, (III) pain scores, and (IV) patient reported outcome scores in patients who used this device as part of management of their knee OA. Methods We retrospectively reviewed patients who received mobile-app controlled NMES therapy for knee OA who were enrolled in this multi-center study between April 2017 and July 2018 in a cloud-based provider online portal system. A total of 41 patients met all our inclusion and exclusion criteria and were included in our final analysis. For each patient, the total number of NMES sessions, the duration of NMES therapy, visual analogue pain scores, ROM, and the Knee injury Osteoarthritis Outcome Score (KOOS, JR) were collected and analyzed. Patient's utilization trends were reported through analyzing NMES sessions and therapy durations. Descriptive statistics were utilized to analyze all relevant values. Results Across all patients, NMES therapy was utilized for an average of 3.5 months (range, 2 weeks to 10 months). On average, 90 sessions (range, 6 to 487) of therapy were received by patients for an average of 1,819 minutes (range, 120 to 9,740 minutes). Overall, patients achieved a mean ROM of 99˚±4.3˚ at final follow-up. Pain scores reduced from a mean of 5 points prior to device use (range, 1 to 8 points) to 2.5 points after use (range, 0 to 6 points) (P<0.001). Evaluation of KOOS questionnaires available for 17 patients showed incremental improvement from 52.46 points when therapy was started, to 63 points at 6 months following NMES therapy. No complications or adverse events were reported from any of the participants. Conclusions Although NMES therapy has been reported on by multiple authors, including in knee OA, there are limited have been no studies that have reported on the compliance, feasibility, and patient outcomes of using a mobile-app controlled NMES therapy devices in the setting of knee OA. Furthermore, the incorporation of cloud-based provider online platform may offer an additional advantage by allowing clinicians to monitor the progress and compliance of their patients in real-time. Therefore, patients who are making sub-optimal progress may benefit from an early intervention to modify their therapy protocol to achieve the best outcome.
Collapse
Affiliation(s)
- Assem A Sultan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Linsen T Samuel
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Anil Bhave
- Rubin Institute of Advanced Orthopedics, Rehabilitation Department, Sinai Hospital, Baltimore, MD, USA
| |
Collapse
|
10
|
Burgess LC, Swain ID, Taylor P, Wainwright TW. Strengthening Quadriceps Muscles with Neuromuscular Electrical Stimulation Following Total Hip Replacement: a Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-00225-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
11
|
Abstract
BACKGROUND The comparative effectiveness of neuromuscular electrical stimulation (NMES), transcutaneous electrical nerve stimulation (TENS), and electroacupuncture (EA) for improving patient rehabilitation following total knee arthroplasty (TKA) is controversial. Therefore we conducted this systematic review to assess the available evidence. METHODS The PubMed, OVID, and ScienceDirect databases were comprehensively searched and studies were selected and analyzed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Data were extracted and qualitatively synthesized for several outcomes. RESULTS Data were analyzed from 17 randomized controlled trials involving 1285 procedures: 8 NMES studies (608 procedures), 7 TENS studies (560 procedures), and 2 EA studies (117 procedures). Qualitative analysis suggested that NMES was associated with higher quadriceps strength and functional recovery after TKA. Recovery benefits were maximal when the stimulation was performed once or twice a day for 4-6 weeks at an intensity of 100-120 mA and frequency of 30-100 Hz. The electrode should be sufficiently large (100-200 cm2) to reduce discomfort. TENS at an intensity of 15-40 mA and frequency of 70-150 Hz provided effective analgesia after TKA. EA at an intensity of 2 mA and frequency of 2 Hz may also provide postoperative analgesia of TKA. CONCLUSION As adjunct modalities, NMES and TENS can effectively improve rehabilitation after TKA without triggering significant intolerance, and maximal benefits depend on optimized parameters and intervention protocols. EA may be an effective adjunct modality for analgesia after TKA.
Collapse
|
12
|
De Oliveira PFA, Durigan JLQ, Modesto KAG, Bottaro M, Babault N. Neuromuscular fatigue after low- and medium-frequency electrical stimulation in healthy adults. Muscle Nerve 2018; 58:293-299. [PMID: 29687898 DOI: 10.1002/mus.26143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2018] [Indexed: 11/10/2022]
Abstract
INTRODUCTION In this study we investigated fatigue origins induced by low-frequency pulsed current (PC) and medium-frequency current (MF) neuromuscular electrical stimulation (NMES) after a clinical-like session. METHODS Eleven healthy men randomly underwent 2 NMES sessions, PC and MF, on quadriceps muscle (15-minute duration, 6 seconds on and 18 seconds off). Maximal voluntary contraction (MVC), central activation ratio (CAR), vastus lateralis electromyographic activity (EMG), and evoked contractile properties were determined before and after the sessions. Evoked torque and discomfort during the sessions were also measured. RESULTS Both currents produced decreases in MVC, EMG, and evoked contractile properties after the sessions. No difference was found between currents for all variables (P > 0.05). Evoked torque during sessions decreased (P < 0.05). No difference was observed in mean evoked torque and discomfort (P > 0.05). DISCUSSION Both currents induced similar neuromuscular fatigue. Clinicians can choose either PC or MF and expect similar treatment effects when the goal is to generate gains in muscle strength. Muscle Nerve 58: 293-299, 2018.
Collapse
Affiliation(s)
- Pedro Ferreira Alves De Oliveira
- Federal Institute of Brasília, Brasília, Federal District, 72015-606, Brazil.,College of Physical Education, University of Brasília, Brasília, Federal District, Brazil
| | - João Luiz Quagliotti Durigan
- College of Physiotherapy, University of Brasília, Brasília, Federal District, Brazil.,College of Physical Education, University of Brasília, Brasília, Federal District, Brazil
| | | | - Martim Bottaro
- College of Physical Education, University of Brasília, Brasília, Federal District, Brazil
| | - Nicolas Babault
- Centre d'Expertise de la Performance, CAPS, U1093 INSERM, Université de Bourgogne, Faculté des Sciences du Sport, Dijon, Bourgogne, France
| |
Collapse
|