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.