An evaluation of neuromuscular electrical stimulation in critical care using the ICF framework: a systematic review and meta‐analysis

Abstract

Objective: To review, in conformance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the totality of evidence for the use of neuromuscular electrical stimulation (NMES) . Limits of the English language and human studies were applied. Study Selection: Trials investigating the effect of NMES in critical care adult patients were included. One reviewer excluded articles by title. Two reviewers excluded remaining articles by abstract and full text. One reviewer extracted data under a standardised form. Two reviewers assessed methodological quality using the Cochrane Risk of Bias Tool and the Newcastle Ottawa Scale. Results: Twelve full-text articles, eleven randomised controlled trials (RCTs) and one case-control trial indicated the potential of NMES to preserve muscle mass and joint range of motion, improve outcomes of ventilation, and reduce activity limitations. Meta-analysis from three RCTs supported NMES to preserve muscle strength using a fixed-effects model [n = 146; standardised mean difference 0.93 (0.51, 1.35) P = 0.0002]; however, significant heterogeneity was recorded. No outcomes evaluated the effect on participation restrictions. Conclusion: NMES, as an adjunct to current rehabilitation practices in critically ill patients, may maintain muscle strength. However, high-quality studies with longer follow-up periods and standardised outcome measures across all domains of the ICF framework are required. Authorship and contributorshipMs Dearbhla Burke designed and performed the electronic database search, screened the articles for inclusion, evaluated the quality of the included studies, collected the data, completed narrative analysis and statistical meta-analysis, and wrote the paper. Ms Emma Gorman designed the concept of the review, contributed to search strategy development, and acted as a third party to resolve disagreements regarding screening and quality assessment. Mr Diarmaid Stokes assisted in study design and the development of a search strategy, provided training and assistance with Endnote bibliography software, and retrieved full-text articles using inter-library loans. Dr Olive Lennon designed the study, screened articles for eligibility, completed quality assessment of papers, discussed statistical analysis and reviewed report writing. EthicsAs a systematic review of published data, this study required no ethical approval.

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

“…This body of evidence can be said to be inadequate, in consideration of the low number of subjects in the electric muscle stimulation group and the associated risk of bias, in addition to the lack of a high‐quality systematic review or meta‐analysis at this time. Three single‐center RCTs examining whether muscle mass increases as a result of electrical muscle stimulation437, 438, 439 were identified and subjected to a meta‐analysis 440. Although subject muscle mass increased significantly, the total number of subjects in the electric muscle stimulation group was low (72 subjects) and the bias risk was high, and accordingly, this evidence may be considered to be of poor quality.…”

Rehabilitation in the intensive care unit: electrical stimulation of skeletal muscles

“…Можно отметить, что ранее только единичные работы были посвящены использованию ЭСМ в ОРИТ. В по-следние годы возросло число таких исследований [29][30][31] и стали появляться попытки систематизировать нако-пленный опыт [35][36][37].…”

“…Кроме того, данные о возможности использования ЭСМ у пациентов с имплантированными кардиостимуляторами [38] должны способствовать умень-шению количества ограничений при наборе групп иссле-дования, поскольку положительное влияние ЭСМ на со-стояние скелетной мускулатуры не вызывает сомнений. Как отмечают авторы недавнего систематического обзора [36], исследовательские группы применения ЭСМ в ОРИТ используют гетерогенный набор тестов для оцен-ки эффективности (табл. 3).…”

“…Кроме того, в некоторых работах в качестве контроля выступает про-тивоположная конечность, а ряд исследований имеют не-рандомизированный дизайн или могут иметь ограниче-ния вследствие недостаточного «ослепления». К схожим выводам пришли и авторы систематических обзоров, про-демонстрировав, что об эффективности ЭСМ в ОРИТ го-ворить преждевременно, и основные препятствия заклю-чаются в неоднородности методик стимуляции и методов оценки результатов [35][36][37]. Тем не менее каждая из при-веденных методик оценки достаточно информативна и позволяет объективизировать полученный в результате ЭСМ эффект.…”

Intensive Care Unit Acquired Weakness (ICU-AW): a brief and practical review

“…Finally, electrical muscle stimulation (EMS) may be an alternative therapy for patients who cannot actively exercise or others disabling comorbidities and in patients unable to cooperate [102]. This technique may maintain muscle strength and joint range of motion, improve outcomes of ventilation, and reduce activity limitations [103].…”