Adherence to Neuromuscular Electrical Stimulation Interventions for Muscle Impairment in Hip and Knee Osteoarthritis: A Systematic Review

Abstract

Background: Neuromuscular electrical stimulation (NMES) provides a promising approach to counteract muscle impairment in hip and knee osteoarthritis, and to expedite recovery from joint replacement surgery. Nonetheless, application into clinical orthopaedic practice remains limited, partly due to concerns regarding patient tolerance. Objectives: This systematic review aimed to quantify levels of adherence to NMES interventions for muscle impairment in hip and knee osteoarthritis and identify strategies to increase compliance. Data Sources: Randomised controlled trials (RCTs) were identified in a web-based literature review, completed in December 2020. The databases sourced included the Cochrane Library, CINAHL Complete, Medline Complete and PubMed. Eligibility Criteria: Studies were included if they were: (i) conducted in cohorts of adults with hip or knee osteoarthritis; (ii) a protocol of electrical muscle stimulation prescribed to treat muscle impairment; and (iii) reported intervention adherence or attrition rate. Data were extracted on adherence rate, reasons for non-adherence and potential strategies to increase adherence. Risk of bias was assessed using the Physiotherapy Evidence Database (PEDro) scale. Results: The search yielded 120 articles, of which 15 studies were considered eligible and included in the analysis (n = 922). All NMES treatment was applied to the quadriceps, with 1 study targeting the quadriceps and calves. The mean PEDRO score of the included studies was 6.80 out of a possible 10 (range 6-8). Mean adherence did not differ between groups receiving treatment with NMES (85% ± 12%) and control groups receiving voluntary exercise or education (84% ± 9%) ( P = .97). Reasons for non-adherence or attrition included a dislike of the device, dizziness, pain and discomfort. Strategies to increase adherence included NMES education, a familiarisation period, supervision, setting thresholds based upon patient tolerance, monitoring pain levels during stimulation and using built-in adherence trackers. Conclusions: This systematic review indicates that adherence to NMES interventions for muscle impairment in hip and knee osteoarthritis in clinical trials does not differ to control groups receiving education or voluntary exercise, and hence should not be a barrier to application in clinical practice.

Gene Ontology (GO)-Driven Inference of Candidate Proteomic Markers Associated with Muscle Atrophy Conditions

“…Recently, an in vitro cell culture study with human myofibers using interferon gamma (IFN-γ)-induced muscle wasting corroborated the use of tofacitinib and baricitinib (JAK/STAT inhibitors), two commonly prescribed therapeutics for rheumatoid arthritis (RA), which fully hindered muscle atrophy [ 89 ]. Additionally, neuromuscular electrical stimulation (NMES) which today lacks clinical adherence [ 90 ], could be used as a surrogate for physical exercise since it elicits skeletal muscle hypertrophy [ 91 ] and its efficacy is also currently under study with the joint administration of branched-chain amino acids (BCAA) in a cohort with liver transplantation [ 92 ].…”

Physiotherapeutic Strategies and Their Current Evidence for Canine Osteoarthritis

“…However, a systematic comparative review did not confirm a significant NMES-induced pain reduction for human knee OA [ 158 ]. In people with knee OA, adherence to NMES based therapy has not been superior or inferior to voluntary exercise programmes with patient education [ 163 ]. Currently, NMES frequencies of 25–50 Hz with 150 and 250 ms pulse duration are recommended for muscular strengthening in people, while dogs often tolerate lower frequencies (<10 Hz) better [ 156 ].…”

The effect of neuromuscular electrical stimulation on the human skeletal muscle transcriptome

“…24 Yet, one limitation with current NMES is the high degree of pain and discomfort, 25,26 and time-consuming set-up of the apparatus, leading to low compliance. 27,28 To overcome such an accessibility barrier, textile NMES-electrodes have been integrated into elastic training pants (NMES-pants), which increases NMES compliance. 29,30 However, whether 20% of MVC can be achieved using NMES-pants to provoke early molecular effects of NMES in parity with EX effects is unknown.…”