| Methods |
A pre test, post test randomised double blind control group design. There were 30 subjects randomly assigned to one of four groups. Patterned neuromuscular stimulation (PNMS) group received a pattern of stimulation replicating the discharge of a fatigued quadriceps femoris motor unit (QFMU), uniform frequency neuromuscular group received stimulation with the same mean rate as the PNMS stimulation (8.4Hz), random pattern neuromuscular stimulation received a stimulation pattern generated by randomly shuffling the inter pulse intervals in the fatigued QFMU and the sham stimulation group received stimulation comprising a single 300 microsecond impulse every three minutes. |
| Participants |
All subjects were recruited from a waiting list of people listed for knee replacement surgery. There were 13 male and 17 females with a median age of 69 years (range 57 to 78). There were 30 subjects in total although the numbers allocated to each group were not specified. |
| Interventions |
All subjects stimulated their quadriceps using a pre‐set programme of neuromuscular stimulation for three consecutive hours per day for 6 weeks. Output intensity was set by the subjects as the minimal intensity required to produce a visible and palpable muscle contraction. |
| Outcomes |
Strength, endurance, cross sectional area, timed 10 meter walk, timed sit to stand and quality of life using part two of the Nottingham health profile was recorded. |
| Notes |
The results are presented as percentage change values in isometric torque, quadriceps endurance, timed sit to stand, mean velocity of walking, and mean stride length graphically. No numerical data were provided. The author was contacted but the raw data were no longer available. Interpretation of results directly from the graphs was not attempted. There was no significant difference reported between the frequencies with regard to strength and endurance and no significant difference between frequencies for function, cross sectional area and quality of life. |
| Risk of bias |
| Bias |
Authors' judgement |
Support for judgement |
| Adequate sequence generation? |
Unclear risk |
Trial stated as randomised but no method described. |
| Allocation concealment? |
Unclear risk |
No information given to permit judgement on method of concealment allocation. No method of attempting to conceal allocation of subjects to either the control or experimental groups is stated. |
| Blinding?
All outcomes |
Unclear risk |
Study described as double blinded but it is not stated who was blinded i.e. patients treatment staff or assessors. The text stated that patients were instructed not to discuss treatment with staff to maintain blindness but no further detail was included. |
| Incomplete outcome data addressed?
All outcomes |
Unclear risk |
Two participants dropped out at weeks 7 and 11. No information was given as to which group they belonged to. No method of dealing with participant attrition was described |
| Free of selective reporting? |
High risk |
No raw data was available for this study and the outcomes were not given as group means but described in percentage improvements from baseline in graphical representation only. It was therefore not possible to carry out a meta‐analysis on this data thus indicating a high risk of bias of selective reporting. |
| Free of other bias? |
Unclear risk |
Insufficient information was given to assess whether or not the groups were similar at baseline. Thus the overall risk of bias is uncertain |
