Aging Clinical and Experimental Research

, Volume 20, Issue 1, pp 62–66 | Cite as

Randomised controlled trial of electrical stimulation of the quadriceps after proximal femoral fracture

  • Virginia Braid
  • Mark Barber
  • Sarah L. Mitchell
  • Brendan J. Martin
  • Malcolm Granat
  • David J. Stott
Original Article


Background and aims: Proximal femoral fracture is often associated with long-term residual disability. Quadriceps weakness may be a factor in poor outcome. This study aimed to determine whether training of the quadriceps using electrical stimulation (ES) increases leg extensor power and decreases disability in elderly subjects rehabilitating after fracture. Methods: A single-blind randomized controlled trial of elderly postsurgical proximal femoral fracture patients, comparing 6 weeks of supplementary electrical stimulation of the quadriceps (15 patients) to usual physiotherapy alone (11 patients). The electrical stimulation on:off duty cycle was 7:23 seconds, with 36 cycles per session, given daily as an in-patient and twice weekly after discharge. The primary outcome measure was change in leg extensor power (Nottingham Power Rig). Functional mobility (Elderly Mobility Scale), disability (Barthel Index) and health status (Nottingham Health Profile) were also measured. Results: There was no significant difference in change in leg extensor power, or any other outcome measure, in the ES group compared to usualcare controls. Fractured leg extensor power increased by 10.9 (standard error of the mean 2.1) Watts at 6 weeks in the ES group compared to 15.3 (5.5) in the controls (mean adjusted difference −3.1, 95% CI −7.8, 1.6 Watts). Only 3 (20%) of the intervention patients tolerated sufficient stimulation intensity to produce repetitive knee extension, while 11 (73%) sustained palpable or visible contractions with no leg movement. Conclusion: A 6-week program of electrical stimulation of the quadriceps did not increase leg extensor power, or reduce disability, in elderly patients rehabilitating after surgical fixation of proximal femoral fracture. In many patients local discomfort limited the intensity of electrical stimulation that could be delivered.


electrical stimulation proximal femoral fracture quadriceps rehabilitation 


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  1. 1.
    Keene GS, Parker MJ, Pryor GA. Mortality and morbidity after hip fractures. BMJ 1993; 307: 1248–60.PubMedCrossRefGoogle Scholar
  2. 2.
    Marottoli RA, Berkman LF, Cooney LM Jr. Decline in physical function following hip fracture. J Am Geriatr Soc 40: 861–6. 1992.PubMedGoogle Scholar
  3. 3.
    Anianson A, Zetterberg C, Hedberg M, Hendriksson KG. Impaired muscle function with ageing: a background factor in the incidence of proximal femoral fracture. Clin Orthop 1984; 191: 193–202.Google Scholar
  4. 4.
    Lamb SE, Morse RE, Grimley Evans J. Mobility after proximal femoral fracture: the relevance of leg extensor power, postural sway and other factors. Age Ageing 1995; 24: 308–14.PubMedCrossRefGoogle Scholar
  5. 5.
    Mitchell SL, Statt DJ, Martin BJ, Grant SJ. Randomized controlled trial of quadriceps training after proximal femoral fracture. Clin Rehab 2001; 15: 282–90.CrossRefGoogle Scholar
  6. 6.
    Martin TP, Gundersen LA, Blevins FT, Coutts RD. The influence of functional electrical stimulation on the properties of vastus lateralis fibres following total knee arthroplasty. Scand J Rehabil Med 1991; 23: 207–10.PubMedGoogle Scholar
  7. 7.
    Barber M, Braid V, Mitchell SL, et al. Electrical stimulation of quadriceps during rehabilitation following proximal femoral fracture. Int J Rehabil Res 2002; 25: 61–3.PubMedCrossRefGoogle Scholar
  8. 8.
    Lamb SE, Oldham JA, Morse RE, Evans JG. Neuromuscular stimulation of the quadriceps muscle after hip fracture: a randomized controlled trial. Arch Phys Med Rehabil 2002; 83: 1087–92.PubMedCrossRefGoogle Scholar
  9. 9.
    Rooney JG, Currier DP, Nitz AJ. Effect of variation in the burst and carrier frequency modes of neuromuscular electrical stimulation on pain perception of healthy subjects. Phys Ther 1992; 72: 800–9.PubMedGoogle Scholar
  10. 10.
    Kramer JF. Effect of electrical stimulation current frequencies on isometric knee extension torque. Phys Ther 1987; 67: 31–8.PubMedGoogle Scholar
  11. 11.
    Bassey EJ, Short AH. A new method for measuring power output in a single leg extension: feasibility, reliability and validity. Eur J Appl Physiol Occup Physiol 1990; 60: 385–90.PubMedCrossRefGoogle Scholar
  12. 12.
    Presser L, Canby A. Further validation of the Elderly Mobility Scale for measurement of mobility of hospitalised elderly people. Clin Rehab 1997; 11: 338–43.CrossRefGoogle Scholar
  13. 13.
    Mahoney FI, Barthel DW. Functional evaluation: the Barthel index. Maryland State Med J 1965; 14: 61–5.Google Scholar
  14. 14.
    Petrella JK, Miller LS, Cress ME. Leg extensor power, cognition, and functional performance in independent and marginally dependent older adults. Age Ageing 2004; 33: 342–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Internal Publishing Switzerland 2008

Authors and Affiliations

  • Virginia Braid
    • 1
  • Mark Barber
    • 1
  • Sarah L. Mitchell
    • 1
  • Brendan J. Martin
    • 2
  • Malcolm Granat
    • 3
  • David J. Stott
    • 1
  1. 1.Academic Section of Geriatric MedicineGlasgow Royal InfirmaryGlasgowUK
  2. 2.Department of Medicine for the ElderlyHairmyres HospitalUK
  3. 3.Department of BioengineeringStrathclyde UniversityUnited Kingdom

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