A Narrative Review of the Use of Neuromuscular Electrical Stimulation in Individuals With Diabetic Foot Ulceration

Abstract

This review aims to summarize the evidence reported on the use of neuromuscular electrical stimulation (NMES) in individuals with diabetic foot ulceration (DFU). A systematic search of EMBASE and MEDLINE databases was performed in February 2019, using search terms relating to the domains DFU and NMES. All primary evidence assessing outcomes of NMES in DFU were included. Of 344 references obtained from database searching, 7 met the inclusion criteria and included a total of 140 participants, 77 of whom had DFU. All included studies used prospective designs. Two studies demonstrated improvements in chronic ulcer healing with NMES use; however, in each study, only 3 of the included participants had DFU and subgroup analyses based on ulcer etiology was omitted. The remaining 5 studies were produced by the same research group and positive effects of NMES (in combination with heat therapy) on DFU healing were consistently demonstrated. They reported significantly better healing rates with NMES in DFU than in nondiabetic wounds of a similar grade (healing rate: 70.0 ± 32.3% in DFU vs 38.4 ± 22.3% in nondiabetic ulcers [ P < .01]). These studies did not provide data assessing the isolated effects of NMES without concomitant heat exposure. Data on device tolerability and compliance were lacking. The existing data support a potential role for NMES in individuals with DFU; however, the identified studies inadequately controlled for confounding and were underpowered. Given the significant morbidity and mortality associated with DFU, higher quality evidence is needed to assess the adjunctive role for NMES in this group.

Nonpharmacological Management of Diabetic Foot Ulcers: An Update

“…Electrical stimulation is believed to enhance wound healing by imitating the electric current that occurs in injured tissues, thereby inducing cellular proliferation, secretion of growth factors, and inhibition of bacterial growth. 108,109 Some positive results have arisen from clinical studies, but there is not adequate evidence to propose its use in clinical practice. 109,110…”

“…108,109 Some positive results have arisen from clinical studies, but there is not adequate evidence to propose its use in clinical practice. 109,110…”

The effect of electrical stimulation on skin vulnerability to irritants

“…Numerous studies have investigated the clinical effects of electrical stimulation (ES) in humans. Studies have demonstrated that ES is an effective therapeutic modality for strengthening muscles, 1 reducing spasticity, 2 relieving pain, 3 promoting wound healing, 4 increasing skin blood flow, 5 and alleviating itching in certain dermatological conditions 6 …”

Autumn Issue With Gathering Swallows in the Skies

“…Petrakis et al 8 provide an update on the utility and limitations of the newer antibiotic dalbavancin for the treatment of complicated gram-positive skin and soft tissue infections of the lower extremities. Goodall et al 9 shed light on the implications for neuromuscular electrical stimulation in subjects with recalcitrant diabetic foot ulcers.…”