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NMES or RT exercises show similar functional improvement for patients with knee OA
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April 2013
NMES or RT exercises show similar functional improvement for patients with knee OA
Study Type:Therapy
OE Level Evidence:2
Journal Level of Evidence:N/A
Effects of home-based resistance training and neuromuscular electrical stimulation in knee osteoarthritis: A randomized controlled trial
BMC Musculoskelet Disord. 2012 Jul 3;13:118. doi: 10.1186/1471-2474-13-118Did you know you're eligible to earn 0.5 CME credits for reading this report? Click Here
Synopsis
41 patients with moderate to severe knee osteoarthritis were randomized into three groups to assess the efficiency of home-based neuromuscular electrical stimulation (NMES) in strengthening the quadriceps femoris muscle (QFM). Patients received home-based resistance-training (RT), NMES; or standard care. At 14 weeks, similar and significant improvements in functional capacity were seen for the RT and NMES groups compared to the control group and baseline measures.
Publication Funding Details
+
Funding:
Not Reported
Conflicts:
None disclosed
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Yes = 1
Uncertain = 0.5
Not Relevant = 0
No = 0
The Reporting Criteria Assessment evaluates the transparency with which authors report the methodological and trial characteristics of the trial within the publication. The assessment is divided into five categories which are presented below.
3/4
Randomization
4/4
Outcome Measurements
3/4
Inclusion / Exclusion
4/4
Therapy Description
3/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
The Fragility Index is a tool that aids in the interpretation of significant findings, providing a measure of strength for a result. The Fragility Index represents the number of consecutive events that need to be added to a dichotomous outcome to make the finding no longer significant. A small number represents a weaker finding and a large number represents a stronger finding.
Why was this study needed now?
Quadriceps femoris muscle (QFM) weakness is a common symptom of those suffering from knee osteoarthritis (OA), many programs place emphasis on strengthening this muscle group. However, its effectiveness is dependent on good adherence, which can be challenging to achieve for patients with significant knee OA. Due to these limitations, interest has risen in the use of neuromuscular electric stimulation (NMES) to strengthen the QFM. Currently, no studies have compared a home-based NMES program to a home-based exercise program for patients with knee OA.
What was the principal research question?
Did a home-based NMES program show provide similar benefits compared to a home-based exercise program in strengthening the QFM, assessed over a 14 week period?
Study Characteristics
-
Population:
41 patients with symptomatic, moderate to severe knee OA (n = 26 at follow-up).
Intervention:
RT group undertook 3 home-based training sessions per week for 6 weeks (Mean age: 63.9) (n = 14; n = 10 at follow-up).
The NMES group undertook a single 20 minute unsupervised neuromuscular electric stimulation session of the affected QFM, 5 days per week for 6 weeks. A symmetrical bi-phasic square waveform, with a maximum root mean square output current of 18mA and an output frequency of 50 Hz was produced by the NEMS stimulator (Mean age: 63.4) (n = 14; n = 10 at follow-up).
Comparison:
Control group. This group received standard care; this includes OA education, weight loss, pharmacologic therapy, and physical therapy. They were not discouraged from maintaining their existing level of activity (Mean age: 65.2) (n = 13; n = 6 at follow-up).
Outcomes:
The primary outcome measure was objective functional capacity; this was assessed using a 25 m walk test, a repeated chair rise test, and a stair climb test. Secondary outcome measures were Western Ontario McMaster Universities osteoarthritis index (WOMAC) physical function, pain and stiffness scores, Short Form Health Survey (SF-36) physical health and mental health scores, peak isometric and isokinetic quadriceps torque and quadriceps CSA.
Methods:
RCT: Single-blind; Prospective
Time:
14 weeks (assessed at weeks 1, 8, and 14).
What were the important findings?
- No significant intergroup differences in the functional tests were seen between the RT and NMES groups at any time point, but both showed significant improvements compared to the control group at weeks 8 and 14 (P < 0.005).
- No between-group differences were seen in self-reported disability after therapy.
- The only significant intra-group changes were improvements in WOMAC pain score from week 1 to week 8 in favour of the NMES group (P = 0.004); WOMAC physical function for the NMES group at week 13 relative to week 1 (P = 0.004), and an increased SF-36 physical health for the NMES group at week 8 relative to week 1 (P = 0.005).
- No between-group or intra-group differences were reported in isokinetic or isometric quadriceps peak torque after therapy (weeks 8 and 14 relative to week 1).
- Quadriceps cross-sectional area (CSA) was greater (p < 0.005) in the NMES and RT groups at week 8 than week 1 (+5.4% for NMES, +4.3% for RT); there was no difference in quadriceps CSA between the two groups at week 8 (p = 0.404).
- Adherence to the 6-week intervention was not significantly different between the two groups (NMES 91.3%, RT 83.3%, p = 0.324).
What should I remember most?
The study revealed that 6 weeks of NMES or RT exercise resulted in similar and significant improvements in functional performance in patients with moderate to severe knee OA. However, the study found significant intra-group improvements in WOMAC pain and SF-36 physical health for the NMES group, and a trend towards significant intra-group improvements in SF-36 physical and mental health for the RT group at the end of the treatment.
How will this affect the care of my patients?
The use of a neuromuscular electrical stimulation program is an acceptable alternative to resistance training, as it can significantly improve functional performance in patients with moderate to severe OA. Future studies will require a longer follow-up to establish the optimum frequency, intensity, and safety of NMES training.
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