Electromyostimulation and Strength Walking for Knee Injuries: Nurse Managed Care

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 optempo 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) reduces pain and improves quadriceps muscle strength. The overall objective of this project is to compare three nurse-managed treatment regimens for knee injury to the standard WAMC 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 nurse-managed 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 nurse-managed 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 45 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. 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 nurse managed care would be critical for assisting our warriors in a rapid recovery and return to duty.

Final Report is available on NTRL: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2017102...