Neuromuscular electrical stimulation for muscle weakness in adults with advanced disease

Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK.
Cochrane database of systematic reviews (Online) (Impact Factor: 5.94). 01/2013; 1(1):CD009419. DOI: 10.1002/14651858.CD009419.pub2
Source: PubMed

ABSTRACT Patients with progressive diseases often experience muscle weakness, which impacts adversely on levels of independence and quality of life. In those who are unable or unwilling to undertake traditional forms of exercise, neuromuscular electrical stimulation (NMES) may provide an alternative method of enhancing leg muscle strength. Programmes appear to be well tolerated and have led to improvements in muscle function, exercise capacity and quality of life. However, estimates regarding the effectiveness of NMES from individual studies lack power and precision.
Primary objective: to evaluate the effectiveness of NMES for improving muscle strength in adults with advanced disease. Secondary objective: to examine the acceptability and safety of NMES, and changes in muscle function (strength or endurance), muscle mass, exercise capacity, breathlessness and health-related quality of life.
Studies were identified from searches of The Cochrane Library, MEDLINE, EMBASE, CINAHL and PsycINFO databases to July 2012, citation searches, conference proceedings and previous systematic reviews.
We included randomised controlled trials (RCTs) in adults with advanced chronic obstructive pulmonary disease (COPD), chronic heart failure, cancer or human immunodeficiency virus/acquired immunodeficency syndrome (HIV/AIDS) comparing a programme of NMES as a sole or adjunct intervention to no treatment, placebo NMES or an active control. We imposed no language restriction.
Two review authors independently extracted data on study design, participants, interventions and outcomes. We assessed risk of bias using the Cochrane Collaboration's tool. We calculated mean differences (MD) or standardised mean differences (SMD) between intervention and control groups for outcomes with sufficient data; for other outcomes we described findings from individual studies.
Eleven studies involving a total of 218 participants met the inclusion criteria across COPD, chronic heart failure and thoracic cancer. NMES significantly improved quadriceps strength by a SMD of 0.9 (95% confidence interval (CI) 0.33 to 1.46), equating to approximately 25 Newton metres (Nm) (95% CI 9 to 41). Mean differences across various walking tests, favouring NMES, were 40 m (95% CI -4 to 84) for the six-minute walk test, 69 m (95% CI 19 to 119) for the incremental shuttle walk test and 160 m (95% CI 34 to 287) for the endurance shuttle walk test. Limited evidence was available for the assessment of other secondary outcomes.
NMES appears an effective means of improving muscle weakness in adults with progressive diseases such as COPD, chronic heart failure and cancer. Further research is required to clarify its place in clinical practice, by determining the optimal parameters for a NMES programme, the patients most likely to benefit, and its impact on morbidity and service use.

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    • "Randomized controlled trials, with or without crossover strategy, of NMES-based interventions, according to Cochrane Review concept [12], with a comparison group submitted to usual medical care or exercise training. "
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    ABSTRACT: Background Cardiopulmonary exercise testing (CPX) is an important clinical assessment in patients with heart failure (HF). Neuromuscular electrical stimulation (NMES) has shown promise as an approach to improving cardiopulmonary performance during exercise and thus could improve key CPX measures. The primary aim of the proposed study is to perform a systematic review and meta-analysis on the effects of NMES on key CPX measures in HF patients. Methods Data sources: A systematic search without date or language restriction was conducted using Medline,, Cochrane Central Register of Controlled Trials and CINAHL, Amedeo and PEDro. Study eligibility criteria: Randomized controlled trials, with or without crossover strategy, of NMES-based interventions and a comparison group submitted to usual medical care or exercise. Participants and interventions: Systolic HF patients; NMES-based interventions using skin electrodes to produce a muscle contraction. Study appraisal and synthesis methods: Studies were independently rated for quality (The Jadad Scale, PEDro Scale and The Quality of Research Score Sheet). Net changes were compared by weighted mean difference and 95 % confidence interval. Heterogeneity among included studies was explored qualitatively and quantitatively. Begg’s funnel plots and the Egger’s regression assessed publication bias. Results Findings suggest that NMES provides similar gains in CPX performance compared to traditional exercise or usual treatment. Conclusions CPX performance has substantial prognostic and functional importance in the HF population. Our results suggest that NMES improves CPX performance and thus may be a valuable therapeutic intervention, positively altering the clinical trajectory of patients with HF.
    11/2014; 5. DOI:10.1016/j.ijcme.2014.09.003
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    • "An alternative effective intervention to improve muscle recovery is electrical stimulation (ES) (Quittan et al., 2001; Nuhr et al., 2004; Bax et al., 2005; Strasser et al., 2009). ES has been used in clinical settings for rehabilitation purposes, as an alternative therapeutic approach to counteract neuromuscular disability, as well as for muscle strengthening and maintenance of muscle mass in seniors (Maddocks et al., 2013). In addition, there are studies showing that patients with knee osteoarthritis can benefit from the use of ES alone or as an adjunct therapy (Rosemffet et al., 2004; Levine et al., 2013). "
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    ABSTRACT: The loss in muscle mass coupled with a decrease in specific force and shift in fiber composition are hallmarks of aging. Training and regular exercise attenuate the signs of sarcopenia. However, pathologic conditions limit the ability to perform physical exercise. We addressed whether electrical stimulation (ES) is an alternative intervention to improve muscle recovery and defined the molecular mechanism associated with improvement in muscle structure and function. We analyzed, at functional, structural, and molecular level, the effects of ES training on healthy seniors with normal life style, without routine sport activity. ES was able to improve muscle torque and functional performances of seniors and increased the size of fast muscle fibers. At molecular level, ES induced up-regulation of IGF-1 and modulation of MuRF-1, a muscle-specific atrophy-related gene. ES also induced up-regulation of relevant markers of differentiating satellite cells and of extracellular matrix remodeling, which might guarantee shape and mechanical forces of trained skeletal muscle as well as maintenance of satellite cell function, reducing fibrosis. Our data provide evidence that ES is a safe method to counteract muscle decline associated with aging.
    Frontiers in Aging Neuroscience 07/2014; 6(189). DOI:10.3389/fnagi.2014.00189 · 2.84 Impact Factor
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    ABSTRACT: At the present time, there is only one standard test that evaluates the performance of transcutaneous electrical nerve stimulator (TENS) devices. The rationale for this test is not well documented and its scope and limitations are unclear. The thrust of this paper is to discuss the selected factors that are likely to affect the performance standard. These include stimulus waveform, constant current versus constant current voltage output and electrode size. Each of these parameters have been shown to influence the stimulation output and the conductive characteristics of human tissue. Stimulating with different waveforms significantly affects peak current, peak voltage and total pulse charge, but insignificantly affects the phase charge. Using a different electrode size alter all stimulus output values during excitation of peripheral nerves, indicating tile need to specify electrode size for simulated tissue loads. Data show that a single load is not adequate to simulate the conductive medium of human tissue. Instead a family of loads is considered and their validation for testing conditions is discussed
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