Talbot Laura A, Brede Emily, Metter E Jeffrey
College of Medicine, University of Tennessee Health Science Center, Department of Neurology, Memphis, TN 38163, USA.
Mil Med. 2021 May 3;186(5-6):486-492. doi: 10.1093/milmed/usaa513.
Knee injuries associated with intense physical training are one of the most frequent injuries associated with medical encounters for military members. The purpose of this study was to evaluate four approaches to physiotherapy rehabilitation and their effects on work efficiency in active duty military with a knee injury. The four groups included neuromuscular electrical stimulation (NMES), walking with a weighted vest (WALK), combined NMES/Walk, and standard physiotherapy rehabilitation. All groups received standard physiotherapy rehabilitation.We have previously reported that quadriceps muscle strength improved over 18 weeks in the study for the three interventions relative to standard rehabilitation alone. This report presents results from an examination of work efficiency as evaluated during a step test while measuring oxygen utilization.
A randomized controlled trial was conducted, with repeated outcome measures of work efficiency assessed at baseline, 3, 6, 12, and 18 weeks. The sample consisted of 67 active duty service members between the ages of 18 and 50 years with a knee injury. Participants were randomized to one of the four approaches to physiotherapy rehabilitation: (1) NMES was applied to the quadriceps muscle four times per week, for 30 minutes (15 minutes to each leg), consisting of 15 quadriceps muscle contractions per leg; (2) graduated strength walking using a weighted vest (WALK) was for 30 minutes, 3 to 4 days a week; (3) combined NMES with strength walking received both the NMES therapy and the weighted vest walking; and (4) standard physiotherapy consisted of progressive exercise with the number and type of sessions not controlled by the study. All four groups received the standard physiotherapy for a knee injury. The primary outcome was work efficiency, as measured by oxygen utilization during a 2-minute self-paced step test over 18 weeks. The primary analysis used repeated measures, linear mixed-effects models with a random effect for subject.
Both the number of steps performed and gross work efficiency improved during the study for all three intervention groups. For gross work efficiency, standard rehabilitation improved 12%, WALK showed a 19% improvement, NMES increased by 24%, and the NMES/Walk group improved by 40%.
All groups showed improved submaximal exercise efficiency based on oxygen utilization, with the intervention groups showing a greater improvement in work efficiency as compared to standard rehabilitation. Knee injuries can be problematic for active duty members because of reduced mobility leading to deconditioning and associated declines in work efficiency. Rehabilitative programs, including those described in this study, may minimize loss of work efficiency and fitness and promote a quicker recovery.
与高强度体能训练相关的膝伤是军事人员就医时最常见的伤病之一。本研究的目的是评估四种物理治疗康复方法及其对现役军人膝伤工作效率的影响。这四组包括神经肌肉电刺激（NMES）、负重背心行走（WALK）、NMES与行走相结合以及标准物理治疗康复。所有组均接受标准物理治疗康复。我们之前报告过，相对于单独的标准康复，在为期18周的研究中，三种干预措施使股四头肌力量得到了改善。本报告展示了在测量氧气利用率的阶梯试验中对工作效率进行检查的结果。
进行了一项随机对照试验，在基线、3周、6周、12周和18周重复测量工作效率。样本包括67名年龄在18至50岁之间的现役军人，他们均患有膝伤。参与者被随机分配到四种物理治疗康复方法中的一种：（1）每周对股四头肌进行4次NMES治疗，每次30分钟（每条腿15分钟），每条腿进行15次股四头肌收缩；（2）使用负重背心进行渐进式强度行走（WALK），每次30分钟，每周3至4天；（3）NMES与强度行走相结合，同时接受NMES治疗和负重背心行走；（4）标准物理治疗包括渐进式锻炼，疗程的次数和类型不受本研究控制。所有四组均接受针对膝伤的标准物理治疗。主要结果是工作效率，通过在18周内进行的2分钟自定步速阶梯试验中的氧气利用率来衡量。主要分析采用重复测量，使用具有个体随机效应的线性混合效应模型。
在研究期间，所有三个干预组的步数和总体工作效率均有所提高。对于总体工作效率，标准康复提高了12%，WALK提高了19%，NMES提高了24%，NMES/行走组提高了40%。
基于氧气利用率，所有组的次最大运动效率均有所提高，与标准康复相比，干预组的工作效率提高幅度更大。膝伤对于现役军人来说可能会造成问题，因为行动能力下降会导致身体机能下降以及工作效率相关下降。康复计划，包括本研究中描述的那些计划，可能会将工作效率和体能的损失降至最低，并促进更快恢复。
