Effects of combination therapy on the movement function of lower extremity after total knee arthroplasty in the elderly

doi:10.3969/j.issn.2095-4344.2017.31.004

Abstract

Abstract:

BACKGROUND: Electromyographic biofeedback therapy has been reported to contribute to the functional recovery of the lower limb after arthroplasty.

OBJECTIVE: To compare the effect of different rehabilitation therapies on the movement function of lower limb in elderly patients after total knee replacement.

METHODS: Totally153 patients undergoing total knee replacement were randomly divided into conventional, electromyographic biofeedback and combination groups (n=51 per group), and then subjected to the conventional rehabilitation training, electromyographic biofeedback at the quadriceps femoris, and conventional rehabilitation training, electromyographic biofeedback plus body weight supported treadmill training, respectively. At 8 weeks after treatment, the movement function of lower limbs, activities of daily living and balance abilities, range of flexion-extension of the knee joint, walking ability, Hospital for Special Surgery of the lower limbs, as well as the Lower Extremity Functional Scale scores were evaluated. Besides, the Visual Analogue Scale scores, surface electromyogram of the quadriceps femoris at rest and in activity, co-contraction ratio of antagonistic muscle when ankle dorsiflexion, Fugl-Meyer assessment, modified Barthel index, Berg Balance Scale, and Holden walking function classification were detected.

RESULTS AND CONCLUSION: (1) The Visual Analogue Scale scores after treatment in the combination group were significantly lower than those before treatment, in the conventional and electromyographic biofeedback groups (P < 0.01). (2) The Hospital for Special Surgery and Lower Extremity Functional Scale scores in the combination group were significantly higher than those in the conventional and electromyographic biofeedback groups (P < 0.05). (3) The surface electromyogram values, co-contraction ratio of antagonistic muscle, Fugl-Meyer assessment, modified Barthel index, range of flexion-extension of the knee joint, maximum step length and velocity as well as Holden walking function in the combination group were significantly superior to those in the conventional and electromyographic biofeedback groups (P < 0.05). (4) These results indicate that combination therapy is able to significantly improve the movement function and muscle strength of the lower limb, and enhance the postoperative rehabilitation for the elderly after total knee arthroplasty.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Electromyography, Arthroplasty, Replacement, Knee, Recovery of Function

CLC Number:

R318

Chen Hui, Du Shan-shan, Fan Li-juan, Jiang Jie, Liang Xiao-yan, Zhen Ping, Li Xu-sheng, Liu Jun. Effects of combination therapy on the movement function of lower extremity after total knee arthroplasty in the elderly [J]. Chinese Journal of Tissue Engineering Research, 2017, 21(31): 4939-4944.

Figures/Tables 2

2.3 治疗前及治疗8周后3组患者VAS指数、HHS评分、LEFS评分的比较治疗8周后，与常规基础康复组相比，肌电生物反馈康复组VAS评分更低、HHS评分及LEFS评分更高(P < 0.05)；与常规基础康复组和肌电生物反馈康复组分别比较，联合康复组VAS评分更低、HHS评分及LEFS评分更高(P < 0.05)；且3组治疗后VAS指数、HHS评分、LEFS评分，均显著优于治疗前(P < 0.05；见表2)。 2.4 治疗前及治疗8周后3组患者sEMG、踝背伸拮抗肌协同收缩率的比较治疗8周后，与常规基础康复组相比，肌电生物反馈康复组静息状态/主动状态股四头肌积分sEMG、踝背伸拮抗肌协同收缩率差异均有显著性意义(P < 0.05)；与常规基础康复组和肌电生物反馈康复组分别比较，联合康复组患者肌电生物反馈康复组静息状态/主动状态股四头肌积分sEMG、踝背伸拮抗肌协同收缩率差异均有显著性意义(P < 0.05)；且3组治疗后3指标检测结果均优于治疗前(P < 0.05；见表3)。 2.5 治疗前及治疗8周后3组患者FMA评分、MBI指数、BBS评分的比较治疗8周后，肌电生物反馈康复组患者FMA评分、MBI指数、BBS评分均显著高于常规基础康复组(P < 0.05)；联合康复组患者FMA评分、MBI指数、BBS评分均显著高于其他两组(P < 0.05)；且3组治疗后FMA评分、MBI指数、BBS评分均显著高于治疗前(P < 0.05；见表4)。 2.6 治疗前及治疗8周后3组患者膝关节屈伸活动度、Holden步行功能5级人数、最大步速及步长的比较治疗8周后，肌电生物反馈康复组患者膝关节屈伸活动度、Holden步行功能5级人数、最大步速及步长指标显著优于常规基础康复组(P < 0.05)；联合康复组患者膝关节屈伸活动度、Holden步行功能5级人数、最大步速及步长指标均显著优于其他两组(P < 0.05)；且3组治疗后膝关节屈伸活动度、Holden步行功能5级人数、最大步速及步长指标均显著优于治疗前(P < 0.05)，见表5。 2.7 不良反应患者均未发生感染、材料宿主反应及康复训练过程发生的意外损伤。 "

References

[1] 谢青,鲍勇,汤亦婷.人工膝关节置换者康复治疗的特征[J]. 中国组织工程研究与临床康复,2009,13(39):7759-7762.

[2] 王世和.人工膝关节置换:技术发展与临床应用及评价[J].中国组织工程研究与临床康复,2010,14(35):6587-6590.

[3] 区广鹏,肖军,郑佐勇,李贝,刘伟,李干. 老年膝关节骨性关节炎患病危险因素的调查[J].中国组织工程研究,2012,16(50): 9463-9470.

[4] 陈伟,吕红芝,张晓琳,等. 中国中老年人群膝关节骨性关节炎患病率流行病学调查设计[J]. 河北医科大学学报, 2015, 36(4): 487-487.

[5] 宋之明,张晓南,赵承武. 股四头肌功能练习对老年膝关节骨性关节炎清理术后疼痛的长期影响[J].中国老年学杂志, 2014, 34(8): 2270-2271.

[6] Climov D, Lysy C, Berteau S, Dutrannois J. et al. Biofeedback on heart rate variability in cardiac rehabilitation: practical feasibility and psycho-physiological effects.Acta Cardiol. 2014;69(3):299-307.

[7] Collins JD, Markham A, Service K. et al. A systematic literature review of the use and effectiveness of the Computer Assisted Rehabilitation Environment for research and rehabilitation as it relates to the wounded warrior. Work. 2015; 50(1):121-129.

[8] De Nunzio A, Zucchella C, Spicciato F. et al. Biofeedback rehabilitation of posture and weightbearing distribution in stroke: a center of foot pressure analysis.Funct Neurol. 2014; 29(2):127-134.

[9] Popa-Velea O, Purcarea VL. Psychological intervention - a critical element of rehabilitation in chronic pulmonary diseases. J Med Life. 2014;7(2):274-281.

[10] Pietrosimone B, McLeod MM, Florea D. et al. Immediate increases in quadriceps corticomotor excitability during an electromyography biofeedback intervention.J Electromyogr Kinesiol.2015;25(2):316-322.

[11] Giggins O, Sweeney KT, Caulfield B. et al. The use of inertial sensors for the classification of rehabilitation exercises.Conf Proc IEEE Eng Med Biol Soc. 2014;2014: 2965-2968.

[12] 李志斌,冯尚武,黄顺仪,等.肌电生物反馈疗法对脑卒中偏瘫患者下肢运动功能的效果 [J].中国康复理论与实践,2013, 19(11):1046-1048.

[13] Vadnerkar A, Figueiredo S, Mayo NE. et al. Classification of gait quality for biofeedback to improve heel-to-toe gait.Conf Proc IEEE Eng Med Biol Soc. 2014;2014:3626-3629.

[14] Oravitan M, Avram C.The effectiveness of electromyographic biofeedback as part of a meniscal repair rehabilitation programme.J Sports Sci Med. 2013;12(3): 526-532.

[15] Lainiala O, Eskelinen A, Elo P. et al. Adverse reaction to metal debris is more common in patients following MoM total knee replacement with a 36 mm femoral head than previously thought: results from a modern MoM follow-up programme.Bone Joint J. 2014;96(12):1610-1617.

[16] Yano J, Shirahige C, Oki K.Effect of visual biofeedback of posterior tongue movement on articulation rehabilitation in dysarthria patients.J Oral Rehabil. 2015;42(8):571-579.

[17] Moore A, Mannion J, Moran RW. The efficacy of surface electromyographic biofeedback assisted stretching for the treatment of chronic low back pain: a case-series.J Bodyw Mov Ther. 2015;19(1):8-16.

[18] Eid MA, Aly SM, El-Shamy SM. Effect of Electromyographic Biofeedback Training on Pain, Quadriceps Muscle Strength, and Functional Ability in Juvenile Rheumatoid Arthritis.Am J Phys Med Rehabil. 2016;95(12):921-930.

[19] Rayegani SM, Raeissadat SA, Sedighipour L. et al. Effect of neurofeedback and electromyographic-biofeedback therapy on improving hand function in stroke patients.Top Stroke Rehabil. 2014;21(2):137-151.

[20] Kim TE, Mariano ER. Developing a multidisciplinary fall reduction program for lower-extremity joint arthroplasty patients.Anesthesiol Clin. 2014;32(4):853-864.

[21] Yu C, Wang Z, Yu Z. et al. Design of Rehabilitation Training System with Electromyography Feedback for Stroke Patients.Zhongguo Yi Liao Qi Xie Za Zhi. 2015;39(3):187-9, 205.

[22] Azola AM, Sunday KL, Humbert IA. Kinematic Visual Biofeedback Improves Accuracy of Learning a Swallowing Maneuver and Accuracy of Clinician Cues During Training. Dysphagia. 2017;32(1):115-122.

[23] Neblett R.Surface Electromyographic (SEMG) Biofeedback for Chronic Low Back Pain.Healthcare (Basel). 2016;4(2): E27.

[24] 刘玲玲, 冯珍. 肌电生物反馈的临床研究及应用进展[J]. 中国康复医学杂志, 2012, 27(3):289-292.

[25] 玛磊,宋鑫,李美,等. 肌电生物反馈疗法针对股内侧斜肌训练对髌股关节疼痛综合征的治疗作用[J]. 中国运动医学杂志, 2015, 34(12): 1202-1203.

[26] Gálvez-Hernández CL, Rodríguez-Ortiz MD, Del Río-Portilla Y. Biofeedback treatment for acute whiplash patient.Rev Med Inst Mex Seguro Soc. 2016;54(4):480-489.