Department of Neurology, College of Medicine, University of Tennessee Health Science Center, 855 Monroe Ave, Suite 415, Memphis, TN 38163.
Physical Therapy Services, Dunham U.S. Army Health Clinic, Carlisle Barracks, PA 17013.
Mil Med. 2020 Aug 14;185(7-8):e963-e971. doi: 10.1093/milmed/usaa037.
Patellofemoral pain syndrome (PFPS) is a common musculoskeletal disorder among military service members that causes knee pain, quadriceps strength loss, and impaired motor performance in otherwise healthy individuals. PFPS poses a threat to the health, fitness, and subsequent readiness of the total force. The goal of rehabilitation for military service members with PFPS is to regain physical capacity of strength and function and to reduce pain, in order to restore readiness in this population. The randomized controlled trial reported here compared an active home exercise program (HEP) alone with three different electrical stimulation treatment regimens implemented concurrently with HEP postulated improvements in lower extremity strength and physical functional performance while also reducing pain in active duty military diagnosed with PFPS.
After baseline testing, 130 active duty military members with PFPS were randomized to 1 of 4 treatment groups: (1) neuromuscular electrical stimulation (NMES) with HEP; (2) transcutaneous electrical nerve stimulation (TENS) with HEP; (3) combined NMES/TENS with HEP; (4) active HEP only. The primary outcome measure was degree of change in knee flexion and extension strength over 9 weeks. Secondary outcomes were physical functional performance and knee pain. The primary analyses used repeated measures, linear mixed-effects models with a random effect for subject, time as a continuous variable, group as a categorical variable, and a group and time interaction to test for differences in change over time among the groups.
All three electrical stimulation treatment groups improved in knee extension strength in the PFPS limb to a greater extent than the HEP alone group over the 9-week treatment period. The NMES and NMES/TENS groups improved to a greater extent than the HEP alone group in knee flexion strength in the PFPS limb. The reported pain improved over time for all treatment groups with no significant group differences. All three stimulation groups performed better on the 6-min walk test than the HEP alone group.
The findings from this study showed that all three electrical stimulation with HEP treatment groups showed greater improvement in strength compared to the HEP alone group. These findings could offer alternative forms of rehabilitation for AD military with PFPS as these treatment regimens can be easily implemented at home station or during deployment.
髌股疼痛综合征（PFPS）是一种常见的肌肉骨骼疾病，在现役军人中引起膝关节疼痛、股四头肌力量丧失和运动表现受损，而这些人在其他方面都是健康的。PFPS 对整个部队的健康、适应性和后续准备构成威胁。PFPS 现役军人康复的目标是恢复力量和功能的身体能力，并减轻疼痛，从而恢复这一人群的适应性。本报告的随机对照试验比较了单独进行主动家庭锻炼计划（HEP）与同时进行三种不同电刺激治疗方案对下肢力量和身体功能表现的改善，同时减轻活跃的 PFPS 现役军人的疼痛。
基线测试后，130 名现役 PFPS 军人被随机分为 4 个治疗组之一：（1）HEP 加神经肌肉电刺激（NMES）；（2）HEP 加经皮神经电刺激（TENS）；（3）HEP 加 NMES/TENS；（4）仅 HEP 主动。主要结局测量是 9 周内膝关节屈伸力量的变化程度。次要结局是身体功能表现和膝关节疼痛。主要分析采用重复测量、线性混合效应模型，以受试者为随机效应，时间为连续变量，组为分类变量，以及组和时间的交互作用，以测试组间随时间的变化差异。
在 9 周的治疗期间，所有三种电刺激治疗组在 PFPS 肢体的膝关节伸展力量方面都比单独 HEP 组有更大的改善。NMES 和 NMES/TENS 组在 PFPS 肢体的膝关节屈曲力量方面比单独 HEP 组有更大的改善。所有治疗组的报告疼痛随时间改善，各组之间无显著差异。所有三种刺激组在 6 分钟步行测试中的表现都优于单独 HEP 组。
本研究结果表明，与单独 HEP 组相比，所有三种电刺激加 HEP 治疗组在力量方面都有更大的改善。这些发现可以为 PFPS 的现役军人提供替代的康复形式，因为这些治疗方案可以在驻地或部署期间轻松实施。
