Effectiveness of neuromuscular electrical stimulation for the rehabilitation of moderate-to-severe COPD: a meta-analysis

Abstract

PurposePatients with COPD often experience skeletal muscle dysfunction. For those who are unable or unwilling to undertake physical training, neuromuscular electrical stimulation (NMES) may provide an alternative method of rehabilitation. The purpose of this meta-analysis was to investigate the controversial topic of whether this therapy is effective in patients with moderate-to-severe COPD.Patients and methodsWe pooled data from nine trials published between January 9, 2002 and January 4, 2016 across PubMed, Embase, Cochrane Central Register of Controlled Trials, Google Scholar, and relevant websites for randomized controlled trials. In these trials, patients with moderate-to-severe COPD were randomly allocated to receive NMES. Primary outcomes were quadricep strength and exercise capacity. The secondary outcome was health-related quality of life.ResultsWe extracted data from 276 patients. NMES contributed to statistically improved quadricep strength (standardized mean difference 1.12, 95% confidence interval [CI] 0.64–1.59, I2=54%; P<0.00001) and exercise capacity, including longer exercise distance (weighted mean difference 51.53, 95% CI 20.13–82.93, I2=90%; P=0.001), and longer exercise endurance (standardized mean difference 1.11, 95% CI 0.14–2.08, I2=85%; P=0.02). There was no significant difference in St George’s Respiratory Questionnaire scores (weighted mean difference −0.07, 95% CI −2.44 to 2.30, I2=56%; P=0.95).ConclusionNMES appears an effectual means of enhancing quadricep strength and exercise capacity in moderate-to-severe COPD patients. Further research is demanded to clarify its effect on other outcomes and determine the optimal parameters for an NMES program.

Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease

“…Although no large RCTs are available, a recent meta-analysis did report improvement in quadriceps strength and exercise capacity with NMES. Unfortunately, no significant improvement in HRQoL in moderate to Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease DOI: http://dx.doi.org /10.5772/intechopen.81742 severe COPD was seen [132]. Apart from debilitated COPD patients, this technology has been recommended for use during COPD exacerbation, as it has low impact on ventilation, heart rate and dyspnea [133,134].…”

Add‐on interventions during pulmonary rehabilitation

“…In COPD patients, several studies have found good evidence that NMES as a stand‐alone intervention compared to sham‐NMES or control is able to significantly increase muscle strength and 6‐min walk distance (6MWD, by 32–43 m) . However, the clinical relevance of NMES as an add‐on tool during PR is not so clear.…”

Exercise assessments and trainings of pulmonary rehabilitation in COPD: a literature review

“…NMES is an alternative method of enhancing quadricep strength and exercise capacity in moderate-to-severe COPD patients. 101 NMES uses various devices, such as low-frequency current, medium-frequency current, monopolar pulses, bipolar pulses, and so forth. 102 Previous studies have shown low-frequency (15 Hz) or high-frequency (75 Hz) NMES to be a suitable rehabilitative modality in severely dyspneic COPD patients.…”