Fitzgerald G Kelley, Piva Sara R, Irrgang James J
Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15260, USA.
J Orthop Sports Phys Ther. 2003 Sep;33(9):492-501. doi: 10.2519/jospt.2003.33.9.492.
Randomized clinical trial, single-masked.
To determine the effectiveness of using a modified neuromuscular electrical stimulation (NMES) training program as an adjunct treatment for improving quadriceps strength and physical function in rehabilitation following anterior cruciate ligament reconstruction (ACLR).
NMES training for quadriceps strengthening has previously been shown to be an effective adjunct treatment following ACLR when performed against isometric resistance using a dynamometer with the knee positioned in flexion. We developed a modified version of published NMES protocol because some patients have difficulty tolerating the existing protocol and many clinics may not have instrumented dynamometers. There is a need to determine the effectiveness of this modified protocol.
Forty-three subjects who had undergone ACLR were randomly assigned to either a group that received (NMES group) or did not receive (comparison group) the NMES treatment in conjunction with their rehabilitation. Group means for quadriceps strength and self-reported measures of knee function were compared after 12 and 16 weeks of rehabilitation. The proportion of subjects in each group achieving clinical criteria to initiate ambulation without crutches, treadmill running, and agility training at selected times during rehabilitation were also compared.
The NMES group demonstrated moderately greater quadriceps strength at 12 weeks (effect size, 0.48), and moderately higher levels of self-reported knee function at both 12 (effect size, 0.72) and 16 (effect size, 0.65) weeks of rehabilitation compared to the comparison group. A greater proportion of subjects in the NMES group achieved clinical criteria for advancing to agility training at 16 weeks.
The modified NMES quadriceps training protocol can be a useful adjunct to ACLR rehabilitation programs, but the treatment effect is smaller than what has been reported in previous studies.
随机临床试验，单盲。
确定使用改良的神经肌肉电刺激（NMES）训练方案作为辅助治疗，以提高前交叉韧带重建（ACLR）术后康复过程中股四头肌力量和身体功能的有效性。
先前的研究表明，在膝关节屈曲位使用测力计进行等长抗阻训练时，NMES训练增强股四头肌力量是ACLR术后一种有效的辅助治疗方法。我们开发了一种已发表的NMES方案的改良版本，因为一些患者难以耐受现有方案，而且许多诊所可能没有配备仪器的测力计。有必要确定这种改良方案的有效性。
43例接受ACLR手术的受试者被随机分为两组，一组接受NMES治疗（NMES组），另一组不接受NMES治疗（对照组），两组均接受康复治疗。在康复治疗12周和16周后，比较两组股四头肌力量的组均值以及膝关节功能的自我报告测量值。还比较了每组中在康复过程中特定时间达到无需拐杖行走、跑步机跑步和敏捷性训练临床标准的受试者比例。
与对照组相比，NMES组在康复12周时股四头肌力量有中度增强（效应量为0.48），在康复12周（效应量为0.72）和16周（效应量为0.65）时膝关节功能的自我报告水平均中度更高。在16周时，NMES组中有更大比例的受试者达到了进入敏捷性训练的临床标准。
改良的NMES股四头肌训练方案可以作为ACLR康复计划的一种有用辅助方法，但治疗效果比先前研究报道的要小。
