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The effectiveness of placebo muscle stimulation in quadriceps muscle rehabilitation: a preliminary evaluation
Oldham J, Howe T
Clinical Effectiveness in Nursing 1997 Mar;1(1):25-30
clinical trial
5/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: No; Blind subjects: Yes; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVES: The objective of this study was to evaluate the effect of placebo and 'active' muscle stimulation in the rehabilitation of quadriceps muscle function in patients with osteoarthritis of the knee. DESIGN: This study compares data collected from four randomly allocated, blindly delivered stimulation patterns: one placebo; one uniform frequency and two variable frequency. Quadriceps muscle stimulation was undertaken over a 6 week period for 3 h per day using a portable electrical stimulator (DMI, PS 1). PARTICIPANTS: Thirty patients with osteoarthritis, affecting one or both of their knee joints, were recruited into the trial. All were recruited from a waiting list for knee joint replacement. MAIN OUTCOME MEASURES: The following measures of quadriceps muscle and lower limb function were undertaken pre and post electrotherapy treatment: quadriceps muscle isometric torque; quadriceps muscle cross-sectional area; timed sit-to-stand; timed velocity of walking and step length. RESULTS: No significant difference in maximum voluntary isometric torque, velocity of walking, step length and cross-sectional area (p = 0.66, 0.86, 0.53 and 0.77 respectively) was observed between the average of the three 'active' stimulation groups compared with the control. This picture was not repeated with an analysis of sit-to-stand time, where there was a significant difference between the placebo and the average of the three other groups (p = 0.03). In this case the placebo group performed considerably worse than the three active treatment groups by 17.5%, 95% Cl (confidence intervals) (-25.21 to -1.165). CONCLUSIONS: This paper describes a model to illustrate the potentially powerful effects placebo treatment can have on human physiological parameters. These effects are discussed in relation to potential confounding variables and the limitations of this study. Suggestions for further research and the clinical potential of this type of treatment are discussed.

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