An Intervention of Electrical Stimulation in Osteoarthritis
Condition: Osteoarthritis
MeSH terms: Osteoarthritis
Study type: Interventional

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.
    

Detailed description: 
      A frequent clinical obstacle encountered in patients with knee osteoarthritis (OA) is an
      inability to achieve full voluntary activation of the quadriceps musculature. This phenomenon
      has been termed arthrogenic muscle inhibition (AMI) and is an ongoing reflex inhibition of
      musculature surrounding a joint following distension or damage to the structures of that
      joint. AMI is a limiting factor in joint rehabilitation as it restricts full muscle
      activation and therefore prevents restoration of strength. Thus, patients often participate
      in life activities deficient in strength and neuromuscular control resulting in altered lower
      extremity mechanics and potentially predisposing patients to further joint degeneration.
      Neuromuscular electrical stimulation (NMES) has been shown to be successful in reversing
      quadriceps AMI, however the duration of its effectiveness and its influence on functional
      outcomes remains elusive. Therefore, the purpose of the proposed study is to examine
      quadriceps activation and functional outcomes following a 4-week NMES protocol in patients
      with medial tibiofemoral osteoarthritis. To examine the efficacy of NMES in reversing AMI and
      improving functional outcomes, 38 subjects will be randomly assigned to either undergo a
      4-week NMES program or to undergo no therapeutic intervention. Prior to treatment and at 1,
      12, and 24 weeks following treatment, patients' quadriceps central activation ratios will be
      assessed. Additionally, subjects will undergo gait and stair climb analyses to determine if
      functional performance during these activities of daily living are improved when compared to
      the baseline assessment. Patients' perceived level of function will also be tested using the
      Western Ontario and McMasters Universities Osteoarthritis Index.
    

Intervention name(s): Electrical Stimulation
Intervention type(s): Device
Intervention description(s): Electrical Stimulation (NMES) will be delivered 3 times per week for 4 weeks
Other intervention name(s): Vectra Genisys
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Arthritis, Knee, Quadriceps, Electrical Stimulation, Women