Electromyostimulation and Strength Walking for Knee Injuries

Knee Injury Clinical Trial

— KI  

Official title:

Electromyostimulation and Strength Walking for Knee Injuries

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02065518
• Other study ID #: HU0001-10-1-TS04
• Secondary ID: TSNRP Grant HU00
• Status: Completed
• Phase: N/A
• Start date: March 2014
• Est. completion date: August 2018

Study information

• Verified date: October 2018
• Source: University of Tennessee
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this project is to compare three treatment regimens for knee injury to the standard rehabilitation protocol: 1) NMES, 2) graduated strength walking (via a weighted vest), and 3) NMES combined with graduated strength walking. Each treatment arm will be supplemented by the standard of care and compared to a group who receive the standard rehabilitation only.

The Study will compare the effects of NMES, Strength Walking and combined NMES/ Strength Walking on strength, mobility, symptomatology, and Quality of Life (QOL) in military members with knee injury to a standard rehabilitation protocol program only. All groups will participate in standard rehabilitation protocol. The groups will be assessed over 18 weeks to compare main and interactive effects over time.

Description:

The prevalence of knee injuries has shown a striking increase of >24% over the last 5 years, affecting work performance, limiting mobility, and impacting military deployment health. This increase reflects the current high op-tempo and frequent deployments of a nation at war including activities related to military operations, physical fitness, and demanding training. We have shown that neuromuscular electrical stimulation (NMES) improves quadriceps muscle strength. We have also shown that a pedometer-based protocol improves fitness. The overall objective of this project is to compare three treatment regimens for knee injury to the standard rehabilitation protocol as potential treatments for improving strength, work efficiency, and mobility in active duty military personnel with a knee injury. Our central hypothesis is that the combination of NMES and walking while wearing a weighted vest will demonstrate greater improvements in muscle strength, work efficiency, and mobility, as compared to the usual care alone. The rationale is that NMES combined with graduated strength walking could produce marked improvements in muscle strength and thereby enhance work performance, readiness and fitness, decrease physical symptoms and faster return to duty. NMES and graduated strength walking, simulate the current uniform in the theatre of operation (body armor).The specific aims are to compare the effectiveness of three treatment regimens to the usual care in improving: (1) muscle strength, (2) work efficiency, (3) mobility, (4) symptoms/pain, and (5) quality of life. After baseline testing, we propose to randomly assign male and female subjects (n=132) ages 18 to 50 years with a knee injury to one of 4 groups: 1) NMES, 2) strength walking, 3) NMES and strength walking, or 4) usual care. All groups will receive 12-weeks of the intervention and 6-weeks of follow-up. Generalized estimating equation (GEE) methods will be used to build regression models for statistical analysis of longitudinal data. If the interventions are effective with respect to parameters of strength, mobility, work performance, and symptoms, recommendations for future treatments can be made. This is hugely important, given the rising rate of knee injuries and the possibility that provider-managed care would be critical for assisting our warriors in a rapid recovery and return to duty.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 78
• Est. completion date: August 2018
• Est. primary completion date: August 2016
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 50 Years

Eligibility

Inclusion Criteria:

• A diagnosis of knee injury (internal derangement of the knee with new effusion, including knee sprain or strains, meniscal tear, cruciate ligamentous tear, and chondral flap or injury);

• A diagnosis of knee pain that is anterior knee pain, overuse pain, patella-femoral pain, and chronic pain (less than 6 months) associated with overuse syndromes which negatively impacts performance by (a) pain in 1 or both knees on most days of the month; b) self reported difficulty performing at least one or more tasks due to pain: stair climbing, rising from a chair, walking or running a quarter mile, repetitive movements such as kneeling or squatting or stooping, pain that inhibits job performance and daily activities;

• Military service member at the time of injury (active duty military and Reserve/ National Guard in active duty status);

• Age =18 and =50 years;

• Ability to provide freely given informed consent.

Exclusion Criteria:

• Fracture or injury to external knee structures such that knee extension or flexion is impaired;

• Evidence of a fracture on radiographs or clinical evidence of unstable tendon tear/rupture;

• A significant co-morbid medical condition (such as severe hypertension or neurological disorder in which NMES strength training or unsupervised exercise is contraindicated and would pose a safety threat or impair ability to participate;

• Inability or unwillingness to participate in a walking or strengthening program;

• Inability to speak and/or read English;

• Reduced sensory perception in the lower extremities;

• Inability to walk on a treadmill without an assistive device;

• Vision impairment, where participant is classified as legally blind;

• Unwillingness to accept random assignment;

• Pregnancy;

• A score of 23 or greater on the Center for Epidemiological Studies- Depression scale (CES-D);

• If the person has a demand type implanted pacemaker or defibrillator.

Related Conditions & MeSH terms

• Knee Injuries
• Knee Injury
• Wounds and Injuries

Intervention

Device:
• NMES
Participants will train at 15-20% of maximal voluntary contraction (MVC) during weeks 1-3, 21-30% of MVC during weeks 3-6 and 31-40% of MVC during weeks 6-9, 41-50% of MVC during weeks 9-12, then sustain 50% of MVC during weeks 12-18. Incremental increases will be made at the 3, 6, 9, and 12-week clinic visits.

Behavioral:
• Strength Walking
Strength Walking participants will maintain a daily training log. Pedometer readings will form the basis for setting activity goals. Initial step goals will be 10% above the average 3-day pedometer step count taken at baseline, with a 10% increase every other week, and then a gradual increase when 30% above the baseline step count has been achieved. At week 7, participants will be given a weighted vest to begin the strengthening component. Participants will be instructed to wear the vest during their 30-minute walk, 3 to 4 days a week. The beginning weight load for the vest will be calculated using 2% of baseline body weight and it will be increased by that same amount every week thereafter until the end of the 12 weeks.
• Standard Rehabilitation Protocol
All participants will receive the current standard of care at the 2 military sites (Walter Reed National Military Medical Center (WRNMMC) and Malcolm Grow Medical Clinics and Surgery Center (MGMCSC)) of the physical therapy rehabilitation protocol for knee injuries. This program includes treatment with a physical therapist at WRNMMC and MGMCSC physical therapy clinic.

Locations

Country	Name	City	State
United States	Malcolm Grow Medical Clinics and Surgery Center	Andrews Air Force Base	Maryland
United States	Walter Reed National Military Medical Cener	Bethesda	Maryland

Sponsors (3)

Lead Sponsor	Collaborator
University of Tennessee	Malcolm Grow Medical Clinics and Surgery Center, Walter Reed National Military Medical Center

Country where clinical trial is conducted

United States, 

References & Publications (2)

Talbot Col Usafr Ret LA, Brede E, Price MN, Zuber PD, Metter EJ. Self-Managed Strength Training for Active Duty Military With a Knee Injury: A Randomized Controlled Pilot Trial. Mil Med. 2019 Jul 1;184(7-8):e174-e183. doi: 10.1093/milmed/usy347. — View Citation

Talbot LA. (2016). Electromyostimulation and Strength Walking for Knee Injuries: Nurse Managed Care. 19 p, NTIS Report No.: PB2017102173.

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Lower Extremity Muscle Strength- Extension	Muscle strength was measured with a handheld dynamometer for extensor knee strength of the injured and uninjured knee.	0, 3, 6, 9, 12, and 18 weeks
Primary	Lower Extremity Muscle Strength- Flexion	Muscle strength was measured with a handheld dynamometer for flexor knee strength of the injured and uninjured knee.	0, 3, 6, 9, 12, and 18 weeks
Primary	Lower Extremity Mobility- 6-Minute Walk Test	Mobility was measured by the distance walked at a fast pace over 6-minutes,	0, 6, 12, and 18 weeks
Primary	Lower Extremity Strength- Chair Test	Mobility was measured by the number of complete standing and sitting cycles in 30-seconds	0, 6, 12, and 18 weeks
Primary	Lower Extremity Mobility and Endurance- Step Test	Mobility and endurance were measured by the number of up and down step cycles completed in 2-minutes.	0, 6, 12, and 18 weeks
Secondary	Overall Pain Severity	Pain severity was measured using item 3 from the IDKC Subjective Knee Evaluation: "If you have knee pain, how severe is it?" Participants responded using a scale of 0 (no pain) to 10 (worst pain imaginable). A mean pain score was calculated.	0, 3, 6, 9, 12, and 18 weeks
Secondary	Knee Pain Following Performance Testing- 6-Minute Walk Test	Knee pain intensity after the 6-Minute Walk Test was assessed using the Visual Analog Scale, an 11-point numerical rating scale. Participants rated current knee pain intensity on a scale of 0 (no pain) to 10 (worst pain imaginable). A mean pain score was calculated.	0, 6, 12, and 18 weeks
Secondary	Knee Pain Following Performance Testing- Chair Stand Test	Knee pain intensity after the 30-Second Chair Stand Test was assessed using the Visual Analog Scale, an 11-point numerical rating scale. Participants rated current knee pain intensity on a scale of 0 (no pain) to 10 (worst pain imaginable). A mean pain score was calculated.	0, 6, 12, and 18 weeks
Secondary	Knee Pain Following Performance Testing- 2-Minute Step Test	Knee pain intensity after the 2-Minute Step Test was assessed using the Visual Analog Scale, an 11-point numerical rating scale. Participants rated current knee pain intensity on a scale of 0 (no pain) to 10 (worst pain imaginable). A mean pain score was calculated.	0, 6, 12, and 18 weeks
Secondary	Activities of Daily Living- Knee Symptoms	The Activities of Daily Living Scale was used to measure self-perceived knee symptoms while performing typical activities. The knee symptom subscale ranges from "I do not have the symptom" to "The symptom prevents me from all daily activity". Scores ranged from 0-35. Higher scores are associated with diminished symptoms. A mean score was calculated.	0, 3, 6, 9, 12, and 18 weeks
Secondary	Activities of Daily Living- Activity Limitation	The Activities of Daily Living Scale was used to measure self-perceived limitations while performing typical activities. The limitation subscale ranges from "Activity is not difficult " to "I am unable to do the activity". Scores range from 0-45. Higher scores are associated with diminished symptoms. A mean score was calculated.	0, 3, 6, 9, 12, and 18 weeks