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Tokuda M1,2, Bai D1, Fujimori Y1, Yamada Y1, Sugimori S1, Okuda H1, Ikemoto T1, Shomoto K2
1Heisei Memorial Hospital, Kashihara-City, Nara, Japan, 2Kio University, Graduate School of Health Science, Kitakatsuragi-gun, Nara, Japan
Background: Proximal femoral fracture is often associated with long-term residual disability. Quadriceps weakness may be a factor in poor outcome. Neuromuscular Electrical nerve Stimulation (NMES) has little report for a fracture postoperative early patients, although it is suggested that it is the effective method of muscle strength training.
Purpose: This study aimed to determine whether training of the quadriceps using NMES increases leg extensor power and decreases disability in postoperative early patients rehabilitating after proximal femoral fracture.
Methods: A single-blind, stratified randomized controlled trial by the surgery approach (bipolar hip arthroplasty: BHA, or open reduction and internal fixation: ORIF) of proximal femoral fracture patients. Seventy-eight patients were randomly divided into two groups: NMES group (39 patients) or no NMES (control) group (39 patients). There were no differences between the groups with regard to age, height, and weight. All patients in both groups received a standard rehabilitation.
Two pairs of adhesive electrodes were placed on the femoral nerve and the motor points of quadriceps (rectus femoral, vastus medial, vastus lateral). The NMES unit we used (ESPURGE, ITO Co., JPN) provides the parameters - waveform: symmetric biphasic pulse wave, pulse duration: 300 µs, frequency: 80Hz, on:off duty cycle: 5:7 seconds, duration: 20 min/day - were taken during admission.
We measured leg extensor power (% body weight) by using a hand held dynamometer (µtasF-1, Anima Co., JPN), the Japanese Orthopedic Association Scoring (JOA) score, and the days taken for a cane walk to become independent.
Two-way ANOVA with repeated measurements was used to evaluate the effect of the intervention and the assessment timepoint, for the leg extensor power and the JOA score. The Mann-Whitney U-test was used to compare NMES group with control group, for the days taken for a cane walk to become independent. P value less than .05 were considered significant. In addition, we calculated the effect sizes for each the surgery approach.
Results: We revealed significant the interaction effect and the main effect of assessment timepoint on the leg extensor power and the JOA score (p .05). Leg extensor power and JOA score were significantly better for the NMES group at 1 week, 2 weeks, 3 weeks and 4 weeks after surgery (p .05). The days taken for a cane walk to become independent were significantly earlier for the NMES group (p .05).
All the effect sizes (leg extensor power, JOA score, the days taken for a cane walk to become independent) were significantly higher for BHA compared with ORIF.
Conclusion(s): The training of the quadriceps using NMES increases leg extensor power and JOA scores, in addition it acquire the earlier independent walking.
Because the effectiveness of NMES is dependent on the surgery approach, therefore it is important to distinguish adaptation.
Implications: A rehabilitation program that includes NMES after proximal femoral fractures provides more rapid improvements in muscle strength and disability than a standard rehabilitation program.
Keywords: neuromuscular electrical nerve stimulation, leg extensor, proximal femoral fracture
Funding acknowledgements: none
Purpose: This study aimed to determine whether training of the quadriceps using NMES increases leg extensor power and decreases disability in postoperative early patients rehabilitating after proximal femoral fracture.
Methods: A single-blind, stratified randomized controlled trial by the surgery approach (bipolar hip arthroplasty: BHA, or open reduction and internal fixation: ORIF) of proximal femoral fracture patients. Seventy-eight patients were randomly divided into two groups: NMES group (39 patients) or no NMES (control) group (39 patients). There were no differences between the groups with regard to age, height, and weight. All patients in both groups received a standard rehabilitation.
Two pairs of adhesive electrodes were placed on the femoral nerve and the motor points of quadriceps (rectus femoral, vastus medial, vastus lateral). The NMES unit we used (ESPURGE, ITO Co., JPN) provides the parameters - waveform: symmetric biphasic pulse wave, pulse duration: 300 µs, frequency: 80Hz, on:off duty cycle: 5:7 seconds, duration: 20 min/day - were taken during admission.
We measured leg extensor power (% body weight) by using a hand held dynamometer (µtasF-1, Anima Co., JPN), the Japanese Orthopedic Association Scoring (JOA) score, and the days taken for a cane walk to become independent.
Two-way ANOVA with repeated measurements was used to evaluate the effect of the intervention and the assessment timepoint, for the leg extensor power and the JOA score. The Mann-Whitney U-test was used to compare NMES group with control group, for the days taken for a cane walk to become independent. P value less than .05 were considered significant. In addition, we calculated the effect sizes for each the surgery approach.
Results: We revealed significant the interaction effect and the main effect of assessment timepoint on the leg extensor power and the JOA score (p .05). Leg extensor power and JOA score were significantly better for the NMES group at 1 week, 2 weeks, 3 weeks and 4 weeks after surgery (p .05). The days taken for a cane walk to become independent were significantly earlier for the NMES group (p .05).
All the effect sizes (leg extensor power, JOA score, the days taken for a cane walk to become independent) were significantly higher for BHA compared with ORIF.
Conclusion(s): The training of the quadriceps using NMES increases leg extensor power and JOA scores, in addition it acquire the earlier independent walking.
Because the effectiveness of NMES is dependent on the surgery approach, therefore it is important to distinguish adaptation.
Implications: A rehabilitation program that includes NMES after proximal femoral fractures provides more rapid improvements in muscle strength and disability than a standard rehabilitation program.
Keywords: neuromuscular electrical nerve stimulation, leg extensor, proximal femoral fracture
Funding acknowledgements: none
Topic: Musculoskeletal: lower limb; Musculoskeletal; Orthopaedics
Ethics approval required: Yes
Institution: Heisei Memorial Hospital
Ethics committee: Heisei Memorial Hospital Ethics Committee
Ethics number: 44576
All authors, affiliations and abstracts have been published as submitted.
