An evaluation of neuromuscular electrical stimulation in critical care using the ICF framework: a systematic review and meta-analysis.

Abstract

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) in the critical care setting, when compared with usual care, under all domains of the World Health Organisation, International Classification of Functioning, Disability and Health (ICF) framework. Six electronic databases were searched: PubMed, Embase, Web of Knowledge, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library and the Physiotherapy Evidence Database (PEDro) (1945-2014). Limits of the English language and human studies were applied. 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. 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. 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.