NMES or RT exercises show similar functional improvement for patients with knee OA .
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(4):37 BMC Musculoskelet Disord. 2012 Jul 3;13:118. doi: 10.1186/1471-2474-13-11841 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.
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)?
Sí = 1
Incierto = 0,5
No relevante = 0
No = 0
La evaluación de los criterios de información evalúa la transparencia con la que los autores informan de las características metodológicas y del ensayo dentro de la publicación. La evaluación se divide en cinco categorías que se presentan a continuación.
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
El Índice de Fragilidad es una herramienta que ayuda en la interpretación de hallazgos significativos, proporcionando una medida de fuerza para un resultado. El Índice de Fragilidad representa el número de eventos consecutivos que es necesario añadir a un resultado dicotómico para que el hallazgo deje de ser significativo. Un número pequeño representa un hallazgo más débil y un número grande un hallazgo más fuerte.
¿Por qué se necesitaba ahora este estudio?
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.
¿Cuál era la pregunta principal de la investigación?
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?
- 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).
¿Qué es lo que más debo recordar?
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.
¿Cómo afectará esto al cuidado de mis pacientes?
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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