The use of neuromuscular electrical stimulation (NMES) as part of the postoperative care regime in orthopaedic patients
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Total Knee Arthroplasty (TKA) is an extremely beneficial procedure carried out primarily as a treatment for end-stage knee osteoarthritis to improve both quality of life and physical functioning. Limitations in physical function and daily physical activity due to osteoarthritis are among the primary reasons for undergoing TKA. As the average age of the world population increases, so will the prevalence of TKA. TKA is generally a very effective and successful procedure but complications can occur and post-surgical functional outcomes can be less than desired. Neuromuscular Electrical Stimulation (NMES) is a technology that may be of great benefit in preventing complications and in enhancing functional recovery post-TKA. NMES has many applications and has been reported to provide benefit in areas such as venous haemodynamics and lower limb muscle strengthening. Within this thesis, the use of NMES as a method of recovery following TKA was examined, focusing on its use in the prevention of venous stasis and as an aid to functional recovery. Regarding the prevention of venous stasis, a systematic review and meta-analysis was carried out to assess the effectiveness of compression therapy, the current mechanical 'gold standard' for venous stasis prevention post- TKA. In addition, a haemodynamic study assessing and comparing the effectiveness of NMES and compression on both velocity and volume measures was carried out in healthy participants. With regard to functional recovery, physical activity was focused upon as one of the main outcomes and as such, an aim within this thesis was to investigate the sensitivity and specificity of a number of activity monitors that have the potential to be utilised by TKA patents post-surgery as a method of monitoring physical activity levels. To assess the effect of NMES on functional recovery, the use of NMES was examined in TKA patients in the acute post- discharge phase. Measures of interest included physical activity levels, joint range of motion and lower limb swelling. Results presented within this thesis demonstrate that the true effectiveness of compression following TKA is as yet unknown and that its use is completely unstandardised. Large, multi-centre, randomised trials with improved reporting are necessary. A comparison of compression to NMES revealed significantly greater improvements in lower limb haemodynamics, in terms of both velocity and volume measures,in healthy participants with use of NMES. With regard to the accurate quantification of physical activity, studies carried out in a range of activity monitors highlight the importance of assessing both the sensitivity and specificity of these monitors. While all monitors tested were found to be sensitive in step detection, both the type of activity carried out and the wear location of the activity monitor had an effect on activity monitor specificity. Use of NMES in TKA patients in the early post-discharge phase showed promising results with regard to physical activity levels as patients in the NMES group were found to spend significantly lesser time sitting/lying, a significantly greater time upright and to carry out a significantly greater number of Stepping Bouts within the early post-discharge period. These results demonstrate the ability of NMES to enhance functional recovery post-TKA in the early post-discharge period and suggest that use of an optimised NMES protocol will most likely provide excellent benefit in TKA patients with regard to improving functional recovery. The findings of this thesis demonstrate the potential role of NMES as part of the post-operative care regime in orthopaedic patients and highlights a number of commercial activity that have the potential to be utilised by TKA patents post- surgery as a method of monitoring physical activity levels.
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