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Effects of leg-press training with moderate vibration on muscle strength, pain, and function after total knee arthroplasty: a randomized controlled trial [with consumer summary]
Bily W, Franz C, Trimmel L, Loefler S, Cvecka J, Zampieri S, Kasche W, Sarabon N, Zenz P, Kern H
Archives of Physical Medicine and Rehabilitation 2016 Jun;97(6):857-865
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; 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: To examine the effects of a time saving leg-press training program with moderate vibration on strength parameters, pain, and functional outcomes of patients following total knee arthroplasty in comparison with functional physiotherapy. DESIGN: Randomized controlled trial. SETTING: Outpatient Rehabilitation Department at a University Teaching Hospital. PARTICIPANTS: Patients (n = 55) with primary total knee arthroplasty (TKA) were randomly allocated into two rehabilitation groups. INTERVENTIONS: Six weeks after TKA, participants either underwent isokinetic leg-press training combined with moderate vibration (LP, n = 26) of 15 minutes duration per session, or functional physiotherapy (PT, n = 29) of 30 minutes per session. Both groups received therapy twice a week for a period of 6 weeks. Participants were evaluated at baseline (6 weeks after TKA) and after the 6 weeks rehabilitation program. MAIN OUTCOME MEASURES: The main outcome measure was maximum voluntary contraction (MVC) of the involved leg. Secondary outcome measures were pain assessed with a visual analogue scale (VAS), range of motion (ROM), stair test (ST), timed up and go test (TUG), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS: Both groups (LP and PT) showed statistically significant improvements in MVC of knee extensors measured on the knee dynamometer (LP from 0.8 +/- 0.06 to 1.0 +/- 0.09 Nm/kg BW, PT from 0.7 +/- 0.06 to 0.9 +/- 0.06 Nm/kg BW, p < 0.05), and in closed kinetic chain on the leg-press (LP from 8.9 +/- 0.77 to 10.3 +/- 1.06 N/kg BW, PT from 6.7 +/- 0.54 to 9.1 +/- 0.70 N/kg BW, p < 0.05), as well as pain at rest (LP from 2.0 +/- 0.36 to 1.3 +/- 0.36 VAS and PT from 1.2 +/- 0.28 to 1.1 +/- 0.31, p < 0.05), WOMAC and functional measurements after 6 weeks of training. There was no significant difference between the two groups concerning strength, pain, and functional outcomes after training (p > 0.05). CONCLUSIONS: Isokinetic leg-press training with moderate vibration and functional physiotherapy are both effective in regaining muscle strength and function after TKA, however, isokinetic leg-press training is considerably less time consuming.

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