Neuromuscular Electrical Stimulation for Treatment of Muscle Impairment: Critical Review and Recommendations for Clinical Practice

Purpose: In response to requests from physiotherapists for guidance on optimal stimulation of muscle using neuromuscular electrical stimulation (NMES), a review, synthesis, and extraction of key data from the literature was undertaken by six Canadian physical therapy (PT) educators, clinicians, and researchers in the field of electrophysical agents. The objective was to identify commonly treated conditions for which there was a substantial body of literature from which to draw conclusions regarding the effectiveness of NMES. Included studies had to apply NMES with visible and tetanic muscle contractions. Method: Four electronic databases (CINAHL, Embase, PUBMED, and SCOPUS) were searched for relevant literature published between database inceptions until May 2015. Additional articles were identified from bibliographies of the systematic reviews and from personal collections. Results: The extracted data were synthesized using a consensus process among the authors to provide recommendations for optimal stimulation parameters and application techniques to address muscle impairments associated with the following conditions: stroke (upper or lower extremity; both acute and chronic), anterior cruciate ligament reconstruction, patellofemoral pain syndrome, knee osteoarthritis, and total knee arthroplasty as well as critical illness and advanced disease states. Summaries of key details from each study incorporated into the review were also developed. The final sections of the article outline the recommended terminology for describing practice using electrical currents and provide tips for safe and effective clinical practice using NMES. Conclusion: This article provides physiotherapists with a resource to enable evidence-informed, effective use of NMES for PT practice. Objectif: en reponse a des demandes de conseils de physiotherapeutes pour optimiser la stimulation musculaire a l'aide de la stimulation electrique neuromusculaire (SENM), une revue, une synthese et une extraction de donnees de la litterature ont ete entreprises par six formateurs, cliniciens et chercheurs en physiotherapie dans le domaine des agents electrophysiques. L'objectif etait de cibler des affections couramment traitees ayant fait l'objet d'une quantite suffisante d'etudes pour tirer des conclusions concernant l'efficacite de la SENM. Les etudes devaient porter sur la SENM produisant des contractions musculaires visibles et toniques. Methodes: quatre bases de donnees electroniques (CINAHL, Embase, PubMed et Scopus) ont ete parcourues a la recherche d'etudes pertinentes publiees entre la creation des bases de donnees et mai 2015. D'autres articles ont ete tires de bibliographies de revues systematiques et de collections personnelles. Resultats: les donnees extraites ont ete synthetisees par consensus des auteurs en vue de dresser des recommandations sur l'optimisation des parametres et des techniques d'application de la stimulation dans le traitement de deficits musculaires associes aux affections suivantes: accident vasculaire cerebral (extremite inferieure ou superieure; aigu ou chronique), reconstruction du ligament croise anterieur, syndrome femoro-rotulien douloureux, arthrose du genou et arthroplastie totale du genou, ainsi que des maladies graves et en stade avance. Les auteurs fournissent egalement un resume des elements cles de chaque etude incluse dans la revue. Enfin, ils recommandent une nomenclature de l'electrotherapie et presentent des conseils pour l'utilisation securitaire et efficace de la SENM. Conclusion: ce document constitue pour les physiotherapeutes une ressource permettant d'appuyer leur utilisation de la SENM sur des donnees probantes.