Neuromuscular Electrical Stimulation improves Activities of Daily Living Post-Stroke: A Systematic Review and Meta-analysis

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1) To elucidate the effectiveness of Neuromuscular Electrical Stimulation (NMES) towards improving activities of daily living (ADL) and functional motor ability post-stroke. 2) Investigate the influence of paresis severity and the timing of treatment initiation for the effectiveness of NMES.

Data Sources
PubMed, MEDLINE, EMBASE, Physiotherapy Evidence Database (PEDro) and Cochrane Library searched for relevant articles from database inception to May 2020.

Study Selection
The inclusion criteria were randomized controlled trials exploring the effect of NMES towards improving ADL or functional motor ability in stroke survivors. The search identified 6064 potential articles with 20 being included.

Data Extraction
Two independent reviewers conducted the data extraction. Methodological quality was assessed using the PEDro scale and the Cochrane Risk of Bias Tool.

Data Synthesis
Data from 428 and 659 participants (mean age 62.4 years; 54% male) for outcomes of ADL and functional motor ability, respectively, were pooled in a random effect meta-analysis. The analysis revealed a significant positive effect of NMES towards ADL (standardized mean difference [SMD] 0.41, 95% confidence interval [CI], 0.14-0.67, P=0.003), whereas no effect on functional motor ability was evident. Subgroup analyses showed that application of NMES in the subacute stage (SMD 0.44, 95% CI 0.09-0.78, P=0.01) and in the upper-extremity (SMD 0.34, 95% CI 0.04-0.64, P=0.02) improved ADL, whereas a beneficial effect was observed for functional motor abilities in severely paretic patients (SMD 0.41, 95% CI 0.12-0.70, P=0.005).

The results of the present meta-analysis are indicative of potential beneficial effects of NMES towards improving ADL post-stroke, whereas the potential for improving functional motor ability appears less clear. Furthermore, subgroup analyses indicated that NMES application in the subacute stage and targeted at the upper-extremity is efficacious for ADL rehabilitation and that functional motor abilities can be positively impacted in severely paretic patients.
Original languageEnglish
Article number100167
JournalArchives of rehabilitation research and clinical translation
Issue number1
Number of pages15
Publication statusPublished - 2022

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