Effect of a Home-based Electrical Stimulation on Quadriceps Function After Knee Surgery
Condition: Post-operative Quadriceps Weakness; Post-operative Quadriceps Inhibition; Adherence to Post-operative Treatment; Post-operative Lower Extremity Function
Study type: Observational

Summary: 
      The purpose of this study is to determine if a home-based electrical stimulation (ES) program
      is more effective than the standard of care (SOC) at improving quadriceps function,
      functional outcomes, patient reported outcomes, and treatment compliance in patients
      recovering from knee surgery. It is hypothesized that there will be significantly better
      outcomes and compliance in ES group when compared to the SOC group.
    

Detailed description: 
      The purpose of this study is to evaluate the effect of home-based neuromuscular electrical
      stimulation applied via a knee sleeve on strength, function, inhibition, and patient reported
      outcomes. Strength will be evaluated via isometric knee extension, neuromuscular inhibition
      will be assessed via a superimposed burst technique, and cortical excitability will be
      assessed via transcranial magnetic stimulation. In addition, we will evaluate function
      through a single-leg hop task, star excursion balance test, and a step down task. Patient
      reported outcomes will be assessed via the: Veterans Rand 12 Item Health Survey (VR-12), Knee
      Osteoarthritis Outcomes Score (KOOS), the International Cartilage Repair Society (ICRS), the
      International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, and the
      Lysholm scale.

      Once a participant is identified as eligible and consents to enroll in the study, they will
      be allocated to either an intervention or control group. The participants in the intervention
      group will receive a knee sleeve that has a neuromuscular ES unit embedded into the garment
      (EMPI Phoenix, DJO Global, Vista, California) in addition to SOC. A superimposed electrical
      signal (maximal toleration) will be utilized during treatment in order to successfully
      overload the muscle. During the electrical stimulation the participants will be instructed to
      perform an isometric contraction and hold this contraction through the length of the
      stimulation. Beginning one week post-operatively the participants will be instructed to
      perform NMES treatment 3 times a day for 20 minutes 5 times a week for 12 weeks. The
      stimulation will be delivered at a frequency of 75Hz with a duty cycle of 4 seconds on and 10
      seconds off. The control group will be treated with the current SOC, performing a home-based
      treatment of volitional isometrics contractions without the addition of neuromuscular
      electrical stimulation beginning on the third day post-operatively. Participants will perform
      20 isometric contractions holding each contraction for 10 seconds 3 times a day 5 times a
      week for 12 weeks. Participants will be instructed to keep a treatment log documenting at
      each session how many exercises and at what intensity they performed.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Patients from the University of Kentucky Orthopaedics and Sports Medicine Clinic who are
        seeking surgical treatment for a disease/injury of the knee.