Functional outcomes post total knee arthroplasty following electrical muscle stimulation on the quadriceps muscle at Chris Hani Baragwanath Academic Hospital
Date
2017
Authors
Rajcoomar, Riona
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Abstract
Background: Known as the largest hospital in the southern hemisphere, Chris Hani
Baragwanath Academic Hospital caterers to a large volume of patients daily. Many of
those patients need surgical procedures and a high turnover rate in relation to
postoperative length of stay in hospital is the norm. However, some elective surgical
procedures, such as total knee arthroplasty, have a prolonged hospital stay possibly
due to the physiotherapy rehabilitation protocol being practiced.
Aim: The aim of this study is to determine whether electrical muscle stimulation on the
quadriceps muscle in addition to the normal physiotherapy rehabilitation protocol will
influence the short-term functional outcomes at six weeks and length of stay in hospital
post total knee arthroplasty when compared with the normal physiotherapy
rehabilitation protocol at Chris Hani Baragwanath Academic Hospital.
Method: A single blinded randomized controlled trial was conducted at Chris Hani
Baragwanath Academic Hospital. Participants were selected from the patients, between
50 and 80 years of age, requiring total knee arthroplasty due to osteoarthritis during the
period of September 2013 to August 2015. The study sample consisted of 52
participants who were randomly allocated into two groups to which the researcher was
blinded. Both groups received the normal physiotherapy rehabilitation protocol. In
addition, the experimental group (group one) started receiving electrical muscle
stimulation 48 hours post-surgery, twice a day for ten minutes until discharge.
Participants were measured for knee range of motion and quadriceps lag
preoperatively, on discharge and at six weeks, using a standard goniometer.
Quadriceps muscle strength was measured preoperatively and at six weeks using a
hand-held dynamometer. Functional assessments were conducted using the Oxford
Knee Score pre-operatively and at six weeks, and the Iowa Level of Assistance Scale
performed daily until discharge.
Results: All 52 (n=48 females and n=4 males) participants who met the inclusion and
exclusion criteria consented to participate in this study. One participant, in the control
group, demised due to medical complications whilst in hospital and no measurements
were obtained on discharge and was therefore excluded from this study. The loss to
follow up in both groups was particularly high at 38.1% (n=16 from a total of n=42) and
36.6% (n=15 from a total of n=41) for groups one (experimental group) and two (control
group) respectively.
The Oxford Knee Score showed no significant difference between the two groups preoperatively
(p=0.55), and at six weeks (p=0.98). The Iowa Level of Assistance scale
showed no significant clinical difference between the two groups on discharge (p=0.38).
There was no significant clinical difference in length of stay in hospital between the two
groups (p=0.38). There was no significant difference in active range of motion between
the two groups pre-operatively (p=0.91), on discharge (p=0.80), and at six weeks
(p=0.61). This study showed the same outcome for passive range of motion between
the two groups preoperatively (p=0.89), on discharge (p=0.87), and at six weeks
(p=0.63).
The data revealed no significant clinical difference in quadriceps muscle strength
between the two groups pre-operatively (p=0.31), and at six weeks (p=0.71).
It was shown there was no significant difference in quadriceps lag between the two
groups preoperatively (p=0.5). However, it was shown that the experimental group
(group one), who had a median of 0 (0-0) quadriceps lag, yielded a significantly
better outcome of quadriceps lag on discharge, than the control group (group two) who
had a mean of 0 (0-5) quadriceps lag (p=0.0019). There is also a significant
difference in quadriceps lag at six weeks, with a mean of 0 (0-0) in the experimental
group (group one) and 0 (0-0) in the control group (group two) (p=0.04).
There was a significant difference between the two groups with regard to days to reach
90 active and passive flexion (p<0.001), and 0 extension range of motion (p=0.0012).
Conclusion: The addition of electrical muscle stimulation on the quadriceps muscle to
the practiced protocol does not significantly influence the short-term functional
outcomes post total knee arthroplasty and did not significantly reduce the length of stay
in hospital. The introduction of physiotherapy rehabilitation over the weekend did
however, see a significant reduction in length of stay compared to previous statistics.
Although there were some significant findings in this study, for now, electrical muscle
stimulation should not be incorporated into the protocol currently being used a Chris
Hani Baragwanath Academic Hospital, but with further research it could be re-looked.
More research with electrical muscle stimulation should be done with more extended
treatment sessions and follow ups at three and six months to determine the long-term
effects of electrical muscle stimulation in this population, and, to determine if the results
of this study is maintained or rendered unchanged.
Description
A dissertation submitted to the Faculty of Health Sciences, University of the
Witwatersrand, in fulfilment of the requirements for the degree of
Master of Science in Physiotherapy
Johannesburg, 2017.
Keywords
Electrical muscle stimulation