PHYSICAL THERAPY & REHAB
Effects of home-based resistance training and neuromuscular electrical stimulation in knee osteoarthritis: A randomized controlled trial
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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)?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
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
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
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.
主な研究課題は何ですか？
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?
重要な知見は？
- 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).
最も覚えておくべきことは？
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.
それが私の患者ケアにどのように影響するか？
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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