Please select the eligibility criteria that correspond to the clinical trial below.
Title: The Efficacy of Neuromuscular Electrical Stimulation for Improving Quadriceps Activation in Women With Medial Tibiofemoral Osteoarthritis
Brief Summary: Patients with knee osteoarthritis (OA) often have decreased thigh muscle strength. This muscle weakness is thought to originate from centers in the brain and spinal cord that restrict recruitment of fibers responsible for muscle contraction. An inability to fully contract muscles surrounding the knee joint impairs patients' abilities to perform activities of daily living (i.e. walking, climbing stairs) and may even contribute to further joint degeneration.

Establishing therapies aimed at increasing muscle strength, restoring normal function, and possibly slowing the processes involved in the development of knee OA is essential in order to enhance the quality of life in the adult population plagued with this degenerative joint condition.

Electrical muscle stimulation applied to the thigh is a promising therapy that has been shown to successfully restore muscle strength, however how long the treatment lasts and its influence on functional outcomes remains unknown. In order for electrical muscle stimulation to be of value it must result in sustained improvements in muscle strength and functional outcomes. Therefore, the purpose of the proposed investigation is to determine if electrical muscle stimulation can restore thigh muscle strength and improve functional outcomes in patients with knee osteoarthritis.


Options:
A: Inclusion Criteria:

* diagnosis of chronic obstructive pulmonary disease
* being 35-75 years of age
* being eligible to participate in endurance trainin
* no acute exacerbation in last month, no change in drugs and no usage of antibiotics in last three weeks

Exclusion Criteria:

* medical conditions which could place patient at risk during neuromuscular electrical stimulation and exercise training (orthophedic and neuromuscular disorders, metal implants in the lower limbs, advanced heart failure, aortic stenosis, deep venous thrombosis a cardiac pacemaker, \>50 mmHg pulmonary artery pressure and/or an acute exacerbation of symtomps in the preceeding four weeks)
* being unable to understand the questionnaires and unable to cooparate.
B: Inclusion Criteria:

* (1) Male or female ≥ 21 and ≤ 80 years of age.
* (2) Current HF symptoms consistent with NYHA class III-IV.
* (3) On stable HF pharmacological therapy for at least one month prior to data collection.
* (4) Left ventricular ejection fraction \< 45% documented within 3 months of enrollment (obtained from subjects medical records).
* (5) No planned elective surgery or pacemaker implantation at the time of study initiation.
* (6) Hgb \> 8.0 within 1 month of enrollment (obtained from subjects medical records).
* (7) Willingness to provide written informed consent.

Exclusion Criteria:

* (1) Inability to provide written informed consent.
* (2) Inability to walk on a treadmill.
* (3) Hemodynamically significant valvular heart disease.
* (4) Unstable angina.
* (5) Acute myocardial infarction within the previous 3 months.
* (6) Obstructive hypertrophic cardiomyopathy.
* (7) HF known to be secondary to pericardial disease or uncorrected valvular disease.
* (8) Chronic oxygen therapy.
* (9) Participation in another clinical trial within the past 30 days.
* (10) Participation in a regular exercise within the previous 6 months.
* (11) Previous implantation of a cardiac pacemaker or defibrillator.
* (12) Pregnancy.
* (13) Resting systolic blood pressure \> 200 mmHg.
* (14) Failure to demonstrate the ability to operate the EMS unit.
* (15) Failure to be compliant with at least 75% of the EMS training sessions.
C: Inclusion Criteria:

* All participants must be female
* Subjects must have radiographic osteoarthritis of grade 2 severity according to the Kellgren and Lawrence scale on the posterior-anterior semi-flexed view with definite osteophytes present in the medial and not lateral compartment.

Exclusion Criteria:

* Previous adverse reaction to electrical stimulation
* Inability to ambulate without the use of an assistive device (i.e cane, walker)
* Patients who have undergone a total knee arthroplasty
* Patients who have torn any knee ligament (ACL, PCL, MCL, LCL)
* Enrollees who have a demand-type cardiac pacemaker or are pregnant
* History of tibial osteotomy surgery
* Significant peripheral or central nervous system disease
* Concurrent clinically active arthritis of the hip, ankle, hindfoot or midfoot in either limb
* Concurrent bilateral radiographic evidence of tibiofemoral osteoarthritis
* Enrollees who are concurrently undergoing physical therapy for pain or OA
* Enrollees who are taking Cox-2 inhibitors or are receiving corticosteroid injections
* Subjects will be allowed to take buffered aspirin and naproxen sodium while enrolled in the study
* Enrollees who have a body mass index of greater than 40 (morbidly obese)
* Enrollees who have a CAR \> .95 (e.g. patients whose quadriceps are uninhibited)
* Enrollees who have previously undergone quadriceps NMES therapy
D: Inclusion Criteria:

* 1 day of mechanical ventilation with an expectation of requiring ≥2 additional days of ICU stay in a Johns Hopkins Intensive Care Unit (ICU)

Exclusion Criteria:

* Unable to understand or speak English due to language barrier or cognitive impairment prior to admission
* Unable to independently transfer from bed to chair at baseline prior to hospital admission
* Known primary systemic neuromuscular disease (e.g. Guillian-Barre) at ICU admission
* Known intracranial process that is associated with localizing weakness (e.g. cerebral vascular accident) at ICU admission
* Transferred from another ICU outside of the Johns Hopkins system after \>4 consecutive days of mechanical ventilation
* Moribund (i.e. \>90% probability of patient mortality in the next 96 hours)
* Anticipated transfer to another ICU for care (e.g. awaiting organ transplantation and transfer to surgical ICU)
* Any pacemaker (e.g., cardiac, diaphragm) or implanted cardiac defibrillator
* Pregnancy
* Body mass index ≥35 kg/m2
* Any limitation in life support other than a sole no-CPR order
* Known or suspected malignancy in the legs
* Unable to treat or evaluate both lower extremities (e.g., bilateral amputation, bilateral skin lesions)
* ICU length of stay \>7 days prior to enrollment

Answer: C