Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli.
Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
Int J Rehabil Res. 2022 Jun 1;45(2):118-125. doi: 10.1097/MRR.0000000000000525. Epub 2022 Mar 7.
Patients undergoing total knee arthroplasty (TKA) show postsurgical quadriceps weakness. Neuromuscular electrical stimulation (NMES) has been shown to be an effective treatment for muscle strength recovery in a number of orthopaedic conditions. The aim of this review is to investigate whether adding NMES to TKA rehabilitation leads to a better quadriceps strength recovery in comparison with standardized rehabilitation. A second aim is to investigate which are the most commonly used NMES pulse settings and their effectiveness. A systematic review of literature was conducted on PubMed, Cochrane, Scopus and Web-of-Science. Intervention studies evaluating the effects of a rehabilitation intervention based on quadriceps NMES in patients undergoing TKA were retrieved. Methodological quality was assessed using the risk of bias-2 Cochrane tool. Features of NMES rehabilitation and technical data on NMES settings were extracted from the studies. Four studies met the inclusion criteria. Due to the limited number and the heterogeneity of the selected studies, it was not appropriate to carry out a meta-analysis. All the studies reported higher quadriceps strength in patients undergoing quadriceps NMES, particularly early after TKA. The addition of NMES or traditional strength training shows similar long-term effects. Short duration and low-intensity NMES have limited effects on quadriceps strength. Heterogeneity was found on NMES methodologies and pulse settings. In conclusion, NMES is effective for quadriceps strength recovery following TKA. NMES intensity and duration are essential for good NMES outcomes on quadriceps strength. Further studies on NMES methodologies, pulse features and settings are required to address the gaps in knowledge on NMES following TKA.
接受全膝关节置换术（TKA）的患者表现出术后股四头肌无力。神经肌肉电刺激（NMES）已被证明可有效治疗多种骨科疾病的肌肉力量恢复。本综述的目的是研究在 TKA 康复中添加 NMES 是否比标准化康复更能促进股四头肌力量的恢复。第二个目的是研究最常用的 NMES 脉冲设置及其有效性。对 PubMed、Cochrane、Scopus 和 Web-of-Science 进行了文献系统评价。检索了评估基于 TKA 股四头肌 NMES 的康复干预效果的干预研究。使用风险偏倚-2 Cochrane 工具评估方法学质量。从研究中提取 NMES 康复的特点和 NMES 设置的技术数据。四项研究符合纳入标准。由于所选研究的数量有限且存在异质性，因此不适合进行荟萃分析。所有研究都报告了接受股四头肌 NMES 的患者的股四头肌力量更高，尤其是在 TKA 后早期。NMES 或传统力量训练的加入显示出相似的长期效果。NMES 持续时间短且强度低对股四头肌力量的影响有限。在 NMES 方法和脉冲设置方面存在异质性。总之，NMES 对 TKA 后股四头肌力量的恢复有效。NMES 的强度和持续时间对 NMES 治疗股四头肌力量的效果至关重要。需要进一步研究 NMES 方法、脉冲特征和设置，以解决 TKA 后 NMES 知识空白问题。
