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: 6.03). 01/2013; 1(1):CD009419. DOI: 10.1002/14651858.CD009419.pub2
Source: PubMed


Individual studies suggest that the use of neuromuscular electrical stimulation, or NMES, may help improve muscle weakness which occurs as a consequence of a progressive disease. NMES uses a lightweight stimulator unit and skin electrodes to produce a muscle contraction. Being a passive form of exercise, it allows patients to exercise their leg muscles at home and unsupervised. This may be particularly helpful for patients who are unable to take part in existing forms of exercise, for example, because of breathlessness or fatigue. This review considers 11 small clinical trials comparing NMES to no exercise or 'placebo NMES' in patients with advanced COPD, chronic heart failure or thoracic cancer. NMES appears to be effective, with programmes leading to improvements in leg muscle strength and ability to exercise. However, these benefits need to be confirmed in larger trials and further research is required to help determine effects on other outcomes such as quality of life and use of healthcare services.

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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.
    Full-text · Article · Nov 2014 · IJC Metabolic and Endocrine
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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.
    Full-text · Article · Jul 2014 · Frontiers in Aging Neuroscience
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    • "Importantly, physical function was strongly associated with worse status for both outcome measures (FACT-G + Pal and POS). The role of rehabilitation is key for patients with progressive illness, as function can be maximised within palliative care planning [32,33]. The worse total scores for Ugandan patients in multivariable analysis may also reflect the referral criteria across countries, in that the Ugandan service may assume care for those with greatest need. "
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    ABSTRACT: Background Despite the high mortality rates of HIV and cancer in sub-Saharan Africa, there are few outcome tools and no comparative data across conditions. This study aimed to measure multidimensional wellbeing among advanced HIV and/or cancer patients in three African countries, and determine the relationship between two validated outcome measures. Methods Cross-sectional self-reported data from palliative care populations in Kenya, Uganda and South Africa using FACIT-G+Pal and POS measures. Results Among 461 participants across all countries, subscale “social and family wellbeing” had highest (best) score. Significant country effect showed lower (worse) scores for Uganda on 3 FACIT G subscales: Physical, Social + family, and functional. In multiple regression, country and functional status accounted for 21% variance in FACIT-Pal. Worsening functional status was associated with poorer POS score. Kenyans had worse POS score, followed by Uganda and South Africa. Matrix of correlational coefficients revealed moderate correlation between the POS and FACIT-Pal core scale (0.60), the FACIT-G and POS (0.64), and FACIT-G + Pal with POS (0.66). Conclusions The data reveal best status for family and social wellbeing, which may reflect the sample being from less individualistic societies. The tools appear to measure different constructs of wellbeing in palliative care, and reveal different levels of wellbeing between countries. Those with poorest physical function require greatest palliative and supportive care, and this does not appear to differ according to diagnosis.
    Full-text · Article · May 2014 · Health and Quality of Life Outcomes
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