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Abstract Number: 418

Dose-Response Relationship between Neuromuscular Electrical Stimulation and Muscle Function in Patients with Rheumatoid Arthritis

Gustavo J. Almeida1, Samannaaz S. Khoja2 and Sara R. Piva1, 1Physical Therapy, University of Pittsburgh, Pittsburgh, PA, 2Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: exercise, muscle biopsy, Muscle strength, physical function and physical therapy

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Session Information

Date: Sunday, October 21, 2018

Session Title: Orthopedics, Low Back Pain and Rehabilitation Poster – ACR/ARHP

Session Type: ACR/ARHP Combined Abstract Session

Session Time: 9:00AM-11:00AM

Background/Purpose: Neuromuscular electrical stimulation (NMES) is a viable intervention to improve impaired muscle function of patients with rheumatoid arthritis (RA). However, there is limited evidence about dose-response of NMES to promote muscle function in these patients. The purpose of this study was to investigate the dose-response relationship between NMES and muscle function in patients with RA and to establish the minimal NMES intensity to promote improvements.

Methods: This was a secondary analysis of pre to post NMES intervention from a randomized study. Participants were adults diagnosed with RA. Participants underwent 36 NMES treatment sessions for the quadriceps muscles over 16 weeks. Muscle function was assessed pre- and post-intervention by the following 3 measures: quadriceps cross-sectional area and muscle quality were quantified using computed tomography, and strength via an isokinetic dynamometer. NMES intensity was calculated in percentage dividing NMES-elicited quadriceps muscle torque by maximum voluntary isometric contraction (MVIC). Improvements in muscle function were calculated using paired samples t-test. Dose-response relationship was determined using curve estimation regression statistics. The minimum NMES intensity was defined as the one sufficient to significantly improve all muscle function measures.

Results: Twenty-four subjects (48 legs) participated (75% female, 58[8] years old, and BMI of 32[7] kg/m2). Quadriceps cross-sectional area, muscle quality and strength improved pre-post intervention (p<.001) (Table 1). Associations between NMES and muscle quality (r2=0.20) and strength (r2=0.23) were significant, but between NMES and muscle cross-sectional area was not (r2=0.02). The minimum NMES intensity necessary to improve all measures of muscle function ranged from 11% to 20% of MVIC (Table 2).

Conclusion: The minimum NMES intensity for significant gains in muscle function is around 15%. Larger NMES intensities may promote better muscle quality and strength in patients with RA.

Table 1: Muscle function pre and post NMES.

Variables

Baseline

Follow-up

Change

95% CI of Change

Quadriceps Cross-sectional Area (cm2)

48.8 (8.5)

52.4 (8.5)

3.6 (2.8)

2.8; 4.4

Quadriceps muscle quality (HU)

45.9 (4.6)

47.4 (5.1)

1.5 (2.3)

0.8; 2.2

Quadriceps Strength (Nm)

144.6 (33.9)

158.6 (36.3)

14.1 (19.8)

8.3; 19.9

Table 2: NMES dose-response of quadriceps muscle function outcomes.

Intensity

(% MVIC)

Muscle Cross-sectional Area

Muscle Quality

Muscle Strength

Change in cm2

95% CI

Change in HU

95% CI

Change in Nm

95% CI

1 to 10 (n=8)

3.23

1.85; 4.61

0.15

-0.89; 1.18

1.16

-7.60; 9.91

11 to 20 (n=7)

3.43

2.40; 4.45

1.18

0.42; 1.95

11.08

4.60; 17.57

21 to 30 (n=13)

3.59

2.45; 4.74

1.87

1.01; 2.73

17.63

10.37; 24.89

31 to 40 (n=6)

3.80

2.61; 4.99

2.40

1.51; 3.29

22.56

15.01; 30.12

41 to 50 (n=4)

3.98

2.76; 5.19

2.58

1.67; 3.49

24.12

16.41; 31.83

51 to 60 (n=10)

4.15

2.34; 5.96

2.48

1.12; 3.84

22.89

11.39; 34.38


Disclosure: G. J. Almeida, None; S. S. Khoja, None; S. R. Piva, None.

To cite this abstract in AMA style:

Almeida GJ, Khoja SS, Piva SR. Dose-Response Relationship between Neuromuscular Electrical Stimulation and Muscle Function in Patients with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/dose-response-relationship-between-neuromuscular-electrical-stimulation-and-muscle-function-in-patients-with-rheumatoid-arthritis/. Accessed June 29, 2022.
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