Highlights
- •The quadriceps activation battery (QAB) is the first clinical battery of tests shown to be related to recovery of activation, strength, and function after total knee arthroplasty (TKA).
- •Timing of assessment of the QAB is critical because patient performance on the QAB was most informative in the initial postoperative period (4d after surgery).
- •The QAB could be used to identify individuals who may need specific interventions such as neuromuscular electrical stimulation to target activation deficits or prolonged physical therapy intervention to achieve optimal results after TKA.
Abstract
Objective
To determine the relation between performance on a clinical quadriceps activation
battery with (1) activation measured by doublet interpolation and (2) recovery of
quadriceps strength and functional performance after total knee arthroplasty (TKA).
Design
Planned secondary analysis of a randomized controlled trial.
Setting
University research laboratory.
Participants
Patients (N=162; mean age, 63±7y; 89 women) undergoing TKA.
Main Outcome Measures
Patients were classified as high (quadriceps activation battery ≥4/6) or low (quadriceps
activation battery ≤3/6) based on performance on the quadriceps activation battery
measured 4 days after TKA. Differences between groups in activation and recovery at
1, 2, 3, 6, and 12 months after TKA were compared using a repeated-measures maximum
likelihood model.
Results
The low quadriceps activation battery group demonstrated poorer quadriceps activation
via doublet interpolation (P=.01), greater quadriceps strength loss (P=.01), and greater functional performance decline (all P<.001) at 1 month after TKA compared with the high quadriceps activation battery group.
Differences between low and high quadriceps activation battery groups on all measures
did not persist at 3 and 12 months (all P>.05).
Conclusions
Poor performance on the quadriceps activation battery early after TKA is related to
poor quadriceps activation and poor recovery in the early postoperative period. Patients
in the low quadriceps activation battery group took 3 months to recover to the same
level as the high quadriceps activation battery group. The quadriceps activation battery
may be useful in identifying individuals who need specific interventions to target
activation deficits or different care pathways in the early postoperative period to
speed recovery after TKA.
Keywords
List of abbreviations:
6MWT (6-minute walk test), MVIC (maximum voluntary isometric contraction), NMES (neuromuscular electrical stimulation), OA (osteoarthritis), SCT (stair climbing test), TKA (total knee arthroplasty), TUG (Timed Up and Go)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 29, 2017
Footnotes
Supported by the National Institutes of Health (grant no. R01-HD065900), National Institutes of Health/National Center for Advancing Translational Sciences (grant nos. UL1-TR001082 and NIH T32 AG00279), and the Foundation for Physical Therapy Promotion of Doctoral Studies I and II Scholarships.
Clinical Trial Registration No.: NCT01537328.
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
