A feasibility randomised controlled trial to evaluate the effectiveness of a novel neuromuscular electro-stimulation device in preventing the formation of oedema following total hip replacement surgery

Wainwright, Tom; Burgess, Louise; Middleton, Robert

doi:10.1016/j.heliyon.2018.e00697

Cited by 12 publications

(10 citation statements)

References 17 publications

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“…Neuromuscular electrical stimulation (NMES) devices are reported to reduce oedema by compressing venous and lymphatic vessels and inducing an increase in venous return and lymphatic flow; 9 however, they are not currently used during routine treatment following an ankle sprain. Preliminary work has found NMES to facilitate a reduction in oedema in other populations, 10,11 and therefore, this pilot study aims to assess the feasibility of a larger trial to determine whether NMES (firefly™ manufactured by Firstkind Ltd., High Wycombe, UK) could help to reduce oedema in ankle sprain patients when used in addition to standard care.…”

Section: Introductionmentioning

confidence: 99%

Does Neuromuscular Electrical Stimulation Improve Recovery Following Acute Ankle Sprain? A Pilot Randomised Controlled Trial

Wainwright

Burgess

Middleton

2019

Clin Med�Insights�Arthritis�Musculoskelet Disord

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Aim: Following soft tissue ankle injury, patients are often referred for out-patient physiotherapy and present symptoms including pain, reduced range of movement and function, and oedema. In this study, we assess the use of a neuromuscular electrical stimulation (NMES) device as an adjunctive therapy to reduce oedema in patients recovering from grade I and II ankle sprains. Methods: This was a single-centre, pilot randomised controlled study, recruiting patients referred to physiotherapy following an ankle sprain. Participants presenting with oedema were randomised to one of two treatment groups: (1) the current standard of care and (2) the current standard of care plus NMES use. Participants were identified in an emergency department and referred to a physiotherapy department for treatment 1 to 5 days following the injury and returned to clinic 7 days later. Results: Twenty-two participants completed the study and had full data sets for analysis (11 in each group). Mean volumetric displacement was reduced in the intervention group in comparison to the standard care group ( P = .011); however, there were no between-group differences in figure of eight measurements, function or pain scores. The device was well tolerated, with no device-related adverse events recorded. Conclusions: In this pilot, randomised controlled trial, NMES was well tolerated by patients following ankle sprain and demonstrated statistically significant improvements in oedema reduction as measured by fluid displacement. No other changes were observed. Further work will need to confirm the clinical significance and effect on longer term recovery post-ankle sprain.

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Section: Introductionmentioning

confidence: 99%

Does Neuromuscular Electrical Stimulation Improve Recovery Following Acute Ankle Sprain? A Pilot Randomised Controlled Trial

Wainwright

Burgess

Middleton

2019

Clin Med�Insights�Arthritis�Musculoskelet Disord

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“…Graduated compression stockings are not pressure-controlled, and rely on the correct measurement on the limb dimensions, the correct choice of garment size, the correct application of the stocking, and the 'normal' shape of the limb. 49,54 Electrical stimulation devices may require correct positioning 55 and output adjustment 56 to achieve a significant haemodynamic effect. Variability in the application of devices can affect multi-centre trials, and further complicate meta-analyses and comparisons between trials.…”

Section: Application and Monitoring Of The Devicementioning

confidence: 99%

Research quality in the study of mechanical methods of deep vein thrombosis prophylaxis

Morris

2019

Phlebology

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There is a lack of good-quality recent clinical data to support the use of mechanical methods to prevent deep vein thrombosis. Recommendations and meta-analyses have to rely on old data from evaluations of devices that are no longer available, with diagnostic methods that are obsolete. The aim of this narrative review is to examine the reasons why better recent evidence is not available, and how this will affect innovation in mechanical deep vein thrombosis prophylaxis. Analysis of recent published trials shows great variability in techniques and technologies, which complicates evaluation of the effectiveness of properties of intermittent pneumatic compression, graduated compression stockings, and electrical stimulation devices. Negative controlled trials have become difficult to conduct, and low rates of deep vein thrombosis have left many comparative trials of devices underpowered. There is a risk that if new approaches to enable clinical research are not developed that technological advancement of mechanical prophylaxis will be inhibited.

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“…10 NMES has also been shown to reduce oedema in patients with lymphedema, 11 and in patients following total hip replacement surgery. 12 NMES has been used successfully to treat hard-to-heal leg ulcers 13,14 and has been shown to promote a significant increase in leg ulcer healing rate. 15 This is a single centre open label study measuring the effect of neuromuscular stimulation on lower limb arterial and venous blood flow in patients with venous leg ulcers.…”

Section: Introductionmentioning

confidence: 99%

Neuromuscular stimulation of the common peroneal nerve increases arterial and venous velocity in patients with venous leg ulcers

Das

Dhoonmoon²,

Chhabra

2020

International Wound Journal

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Activation of the venous muscle pumps by neuromuscular stimulation of the common peroneal nerve has been previously shown to increase venous and arterial flow in the legs of healthy subjects. The aim of this study is to determine whether a similar effect is observed in patients with chronic venous leg ulcers. 1 Hz intermittent electrostimulation of the common peroneal nerve was applied to 14 patients with ulcers between 1 and 10 cm in diameter, eliciting a small, painless, regular, muscular twitch of the leg. Flow was measured using Duplex ultrasound in the popliteal vein and the popliteal artery. Peak arterial velocity increased from 57 to 78 cm/s (P = .001) in sitting position, and from 79 to 98 cm/s in recumbent position (P = .001). Peak venous velocity increased from 10 to 33 cm/s (P = .001) sitting, and from 14 to 47 cm/s (P = .001) recumbent. Significant increases were observed in both venous and arterial blood flow in the lower limb. This suggestsed that activation of the venous muscle pump and improvement of arterial flow assisted oxygen delivery at the wound site. Moreover this may be a worthwhile intervention to assist in the healing of venous leg ulcers, and may provide a mechanistic explanation for the increased healing rates previously reported with neuromuscular stimulation of the common peroneal nerve.

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A feasibility randomised controlled trial to evaluate the effectiveness of a novel neuromuscular electro-stimulation device in preventing the formation of oedema following total hip replacement surgery

Cited by 12 publications

References 17 publications

Does Neuromuscular Electrical Stimulation Improve Recovery Following Acute Ankle Sprain? A Pilot Randomised Controlled Trial

Does Neuromuscular Electrical Stimulation Improve Recovery Following Acute Ankle Sprain? A Pilot Randomised Controlled Trial

Research quality in the study of mechanical methods of deep vein thrombosis prophylaxis

Neuromuscular stimulation of the common peroneal nerve increases arterial and venous velocity in patients with venous leg ulcers

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