Proximal femoral fracture rehabilitation: A randomised controlled trial of electrical stimulation of the quadriceps

Braid, Virginia (2003) Proximal femoral fracture rehabilitation: A randomised controlled trial of electrical stimulation of the quadriceps. MSc(R) thesis, University of Glasgow.

Abstract

Introduction Proximal femoral fracture is associated with high levels of residual physical disability. Quadriceps weakness may be a factor in poor outcome. This research project was an investigation into whether electrical stimulation of the quadriceps of the fractured leg of patients rehabilitating after fixation of proximal femoral fracture increases leg extensor power and decreases disability. Methods A systematic search and structured review of the literature paying explicit attention to study design quality was carried out and a pilot study was undertaken using a case control series design. This was followed by a pragmatically designed, randomised controlled trial of elderly post-surgical proximal femoral fracture patients, that compared 6 weeks of supplementary electrical stimulation (15 patients, mean age 81 years) to standard physiotherapy alone (11 patients, mean age 80 years). The electrical stimulation on: off cycle was 7:23 seconds. The dosage was 36 cycles per session, delivered daily as an in-patient and twice weekly after discharge to the highest intensity patients would tolerate. The primary outcome measure was leg extensor power (Nottingham Power Rig) at 6 weeks (the end of the intervention). Functional mobility (Elderly Mobility Scale), disability (Barthel Index) and perceived health status (Nottingham Health Profile) were also measured. Results The pilot study indicated a potential benefit of the treatment, however the results of the subsequent RCT did not. The RCT sample size had 80% power to detect a significant difference in change in LEP of 0.14W/kg at week 6 compared to baseline. Eleven (73%) of the intervention patients in the RCT tolerated sufficient stimulation intensity to produce only palpable or visible contractions, but no leg movement at initial ES set up. A median of 10 (IQR 6, 17) electrical stimulation sessions were given to those who reached the 6 week assessment (13 (87%)). There were no significant differences in improvement in leg extensor power for either the fractured or non-fractured leg at week 6 or week 14 compared to baseline between the groups. At week 6, the primary end point, the ES group improved fractured leg LEP by a median of 0.20 W/kg (interquartile (IQR) range 0.14, 0.32) compared to 0.22 W/kg (IQR 0.1, 0.43) in the controls. Non-fractured leg LEP improved by a median of 0.18 W/kg (IQR 0.08, 0.38) versus 0.13 w/kg (IQR 0.03, 0.22), respectively. There were no significant differences in change of Elderly Mobility Scale or Barthel score or Nottingham Health Profile between the two groups at any point of assessment. Conclusion ES of quadriceps did not promote increased leg extensor power or reduce disability following proximal femoral fracture. Low stimulation tolerance levels may explain the lack of effect.

• Item Type: Thesis (MSc(R))
• Qualification Level: Masters
• Keywords: Biomechanics, femur, fracture, fractures in old age.
• Subjects: R Medicine > R Medicine (General)
• Colleges/Schools: College of Medical Veterinary and Life Sciences
• Supervisor's Name: Stott, Professor David
• Date of Award: 2003
• Depositing User: Enlighten Team
• Unique ID: glathesis:2003-41193
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 02 May 2019 13:07
• Last Modified: 08 Aug 2022 13:15
• Thesis DOI: 10.5525/gla.thesis.41193
• URI: https://theses.gla.ac.uk/id/eprint/41193