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Neuromuscular stimulation of the quadriceps muscle after hip fracture: A randomized controlled trial,☆☆,,★★,,♢♢,

Presented in abstract form to the British Orthopaedic Research Society's Winter Meeting, 1998, Cardiff, UK.
https://doi.org/10.1053/apmr.2002.33645Get rights and content

Abstract

Lamb SE, Oldham JA, Morse RE, Evans JG. Neuromuscular stimulation of the quadriceps muscle after hip fracture: a randomized controlled trial. Arch Phys Med Rehabil 2002;83;1087-92. Objective: To study the feasibility and effect of neuromuscular stimulation on recovery of mobility after surgical fixation for hip fracture. Design: Double-blind study with stratified randomization. Setting: Home-based rehabilitation program. Participants: Twenty-four women over the age of 75 years with hip fracture. Interventions: Neuromuscular or placebo stimulation of the quadriceps muscle of the fractured leg, applied for 3 hours a day, for 6 weeks, commencing 1 week after surgery. Main Outcome Measures: Recovery of walking speed and ability, postural stability, lower-limb muscle power, and pain at 7 and 13 weeks after surgery. Results: Women in the neuromuscular stimulation group showed faster recovery of mobility. Of the women receiving stimulation, 9 of 12 recovered their prior levels of indoor mobility ability by 13 weeks compared with 3 of 12 in the placebo group (Fisher exact test, P=.046). There were no differences in recovery of walking speed in the first 7 weeks, but women in the stimulation group had greater recovery between 7 and 13 weeks (mean difference=−.13m/s; 95% confidence interval, −.23 to −.01). Conclusions: Neuromuscular stimulation at home is feasible and may be effective in speeding recovery of mobility after surgical fixation of hip fracture. © 2002 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Section snippets

Design

The study was an exploratory trial with stratified randomization and double blinding. It was conducted at the John Radcliffe Hospital Trauma Service, Oxford, UK, and was approved by the local research ethics committee. Informed, written consent was obtained from all participants.

Participants

Three women did not complete the study. One developed myasthenia gravis and another had a severe chest infection. Both required hospitalization, which prevented re-examination in our study. Another woman withdrew her consent to participate a few days after commencing stimulation. Twenty-four women completed the study and were included in the analysis.

The women's characteristics are shown in table 1.

Table 1: Baseline characteristics of women by experimental group

Empty CellPlacebo Stimulation (n=12)PNMS

Discussion

Improving the safety and efficiency of mobility is the primary goal of physical therapy in the postoperative management of patients with hip fracture. Our results suggest that neuromuscular stimulation is a feasible home intervention and is potentially an effective method of speeding up the early restoration of mobility after hip fracture. Although gait speed at 13 weeks was significantly lower than would be expected in healthy women of similar age (.97m/s23), the improvements in walking speed

Conclusion

This study suggests that it is possible to speed the early recovery of mobility, but it is premature to suggest that PNMS is the optimal method and should be adopted for routine clinical use. Although we found statistically significant faster recovery rates, the confidence intervals for the treatment effect were wide.

Acknowledgements

We thank the staff of the Trauma Service at the John Radcliffe Hospital, Oxford. We also thank the anonymous referees for their helpful comments on the manuscript.

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    Supported by grants from Research into Ageing and the PPP Healthcare Charitable Trust.

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    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

    Reprint requests to Sarah E. Lamb, DPhil, Schl of Health and Social Sciences, Coventry University, Priory St, Coventry CV1 5FB, UK, e-mail: [email protected].

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