Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant


Physician Assistant Studies

Department Chair

John Cavenagh, MBA, PhD, PA-C


OBJECTIVE: The objective of this selective Evidence Based Medicine (EBM) review is to determine whether or not neuromuscular electrical stimulation (NMES) as an adjunct to traditional physical therapy (PT) improves post-operative mobility including walking and stairclimbing ability following total knee arthroplasty (TKA) in comparison to traditional PT alone in patients 50-85 years old.

STUDY DESIGN: Review of three English language primary studies published after 1999.

DATA SOURCES: Three randomized controlled trials comparing traditional PT with PT and adjuvant NMES following TKA in patients 50-85 years old found using PubMed and EBSCOhost Web.

OUTCOMES MEASURED: Clinical outcome was measured in each of the three studies through various assessments of post-operative mobility including a six-minute walk test (6MWT), stair-climbing test (SCT), tug up-and-go test (TUG), and walking distance. Each study assessed post-operative improvement from baseline after the respective intervention was introduced.

RESULTS: The study by Petterson et al. revealed no statistically significant difference between interventional and control groups of the RCT cohort, but significant improvements were noted between the RCT and standard of care cohorts. Both RCTs completed by Avramidis et al. and Stevens-Lapsley demonstrated that adjunctive NMES was an effective means to minimize deficits in quadriceps muscle strength and muscle atrophy thereby increasing functional recovery following TKA surgery.

CONCLUSION: The results of the RCTs reviewed suggest NMES is an effective adjunct to traditional PT regimens and permits greater gains in muscle strength and attenuates quadriceps muscle atrophy which allows for more significant functional gains in walking and stair-climbing ability following TKA. Further research needs to be completed to assess appropriate duration and intensity of NMES as well as the potential benefit of pre-operative use ofs NMES.