Performance on a clinical quadriceps activation battery is related to a laboratory measure of activation and recovery after total knee arthroplasty

Publication date: Available online 31 August 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Michael Bade, Tamara Struessel, Roger Paxton, Joshua Winters, Carol Baym, Jennifer Stevens-Lapsley
ObjectiveTo determine the relationship between performance on a clinical quadriceps activation battery (QAB) with 1) activation measured by doublet interpolation and 2) recovery of quadriceps strength and functional performance following total knee arthroplasty (TKA).DesignThis was a planned secondary analysis of a randomized controlled trialSettingUniversity research laboratoryParticipantsOne hundred sixty-two patients (aged 63 ± 7 (mean ± sd) years; 89 females) undergoing TKA participated.Outcome MeasuresPatients were classified as HIGH (QAB ≥ 4/6) or LOW (QAB ≤3/6) based upon performance on the QAB measured 4 days after TKA. Differences between groups in activation and recovery at 1, 2, 3, 6, and 12 months after TKA were compared using a repeated measures maximum likelihood model.ResultsThe LOW QAB group demonstrated poorer quadriceps activation via doublet interpolation (p=0.01), greater quadriceps strength loss (p=0.01), and greater functional performance decline (all p<0.001) at 1 month after TKA compared to the HIGH QAB group. Differences between LOW and HIGH QAB groups on all measures did not persist at 3 and 12 months (all p>0.05).ConclusionPoor performance on the QAB early after TKA is related to poor quadriceps activation and poor recovery in the early postoperative period. Patients in the LOW QAB group took 3 months to recover to the same level as the HIGH QAB group. The QAB may be useful in identifying individuals who need specific interventions to target activation deficits or different care pathways in the early postoperative period to speed recovery after TKA.



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