The effects of adding neuromuscular electrical stimulation to standard inpatient rehabilitation on quadriceps strength and physical function in individuals with total knee replacement

Knee osteoarthritis (OA) is a chronic, costly joint disease and a major contributor to functional limitations in older adults. For patients with end-staged symptomatic knee OA, a total knee replacement (TKR) is commonly indicated and although a TKR does improve selfreport (perceived) physical function and pain, patients who have undergone a TKR continue to show substantial, long-term quadriceps weakness which, in turn, is associated with activity limitations and participation restrictions. Accordingly, conservative, early interventions that effectively improve knee strength in patients with TKR are vital, and neuromuscular electrical stimulation (NMES) is one potential intervention given its ability to improve muscle activation more effectively than do voluntary exercises. Yet, little research has rigorously evaluated its benefits on muscle performance and physical function in patients with TKR. The primary aim of this randomized controlled trial (RCT) is to compare the symptomatic and biomechanical effects of NMES versus static quadriceps exercises in patients who are receiving standard acute TKR rehabilitation. Secondary aims are to assess changes in relevant musculoskeletal impairments with NMES and its cost-effectiveness.