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Cochrane Database of Systematic Reviews

Estimulación eléctrica neuromuscular para la debilidad muscular en pacientes adultos con enfermedades avanzadas

Información

DOI:
https://doi.org/10.1002/14651858.CD009419.pub3Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 17 octubre 2016see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Dolor y cuidados paliativos

Copyright:
  1. Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Sarah Jones

    NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK

    Harefield Pulmonary Rehabilitation Unit, Harefield Hospital, Middlesex, UK

  • William D‐C Man

    NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK

    Harefield Pulmonary Rehabilitation Unit, Harefield Hospital, Middlesex, UK

  • Wei Gao

    Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK

  • Irene J Higginson

    Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK

  • Andrew Wilcock

    Hayward House Macmillan Specialist Palliative Care Unit, University of Nottingham, Nottingham, UK

  • Matthew Maddocks

    Correspondencia a: Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK

    [email protected]

Contributions of authors

All authors were involved in the drafting of the protocol and final review. MM and AW developed the search strategy and searched for and obtained copies of studies for potential inclusion. SJ, WG, AW, and MM selected studies for inclusion, and all authors extracted data from studies and assessed risk of bias. SJ, MM, and WG entered data into Review Manager 5 (RevMan 2014), carried out analyses, and performed the GRADE assessments. All authors interpreted findings and approved the final review manuscript. MM is responsible for conducting any future updates.

Sources of support

Internal sources

  • Department of Palliative Medicine, Nottingham University Hospitals NHS Trust, UK.

    AW is employed by Nottingham University Hospitals NHS Trust.

  • King's College London, Cicely Saunders Institute, Division of Palliative Care, Policy & Rehabilitation, UK.

    MM, WG, and IJH are employed by King's College London.

  • Royal Brompton & Harefield NHS Foundation Trust and Imperial College, UK.

    SJ and WD‐CM are employed by the Royal Brompton & Harefield NHS Foundation Trust.

External sources

  • National Institute of Health Research, UK.

    IJH is a NIHR Senior Investigator. MM is supported by a NIHR post‐doctoral fellowship and a NIHR Clinical Trials Fellowship. MM and IJH are supported by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for South London. WD‐CM is supported by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for North West London, NIHR Clinician Scientist Award, NIHR Clinical Trials Fellowship, and the NIHR Respiratory Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK.

  • Cicely Saunders International, UK.

    MM and IJH are supported by Cicely Saunders International.

  • Medical Research Council, UK.

    WD‐CM is supported by a Medical Research Council (UK) New Investigator Research Grant.

Declarations of interest

SJ: none known. SJ is a physiotherapist and manages patients with respiratory conditions.

WD‐CM is a consultant chest physician and manages patients with respiratory conditions. He has received reimbursement for travel and accommodation costs from Boehringher Ingelheim arising from attendance at the European Respiratory Society Congress meeting in 2013.

WG: none known. WG coauthored one of the studies included in this review (Maddocks 2016a). She was not involved in the data extraction or 'Risk of bias' assessment for this study.

IJH: none known. IJH is a consultant palliative care physician and manages patients with advanced and/or progressive conditions.

AW: none known. AW is a consultant palliative care physician and manages patients with advanced and/or progressive conditions. He coauthored two of the studies included in this review (Maddocks 2009a; Maddocks 2013). He was not involved in the data extraction or 'Risk of bias' assessment for these studies.

MM: none known. MM coauthored three of the studies included in this review (Maddocks 2009a; Maddocks 2013; Maddocks 2016a). He was not involved in the data extraction or 'Risk of bias' assessment for these studies.

Acknowledgements

The 2016 update was undertaken with support from Anna Erskine, Managing Editor, Cochrane Pain Palliative and Supportive Care (PaPaS) Review Group. The search strategy was developed with the assistance of Joanne Abbott, Information Specialist, Cochrane PaPaS Group. Dr Hristina Petkova helped with the eligibility assessment for one excluded study published in Russian (Sumin 2009a).

Cochrane Review Group funding acknowledgement: The National Institute for Health Research (NIHR) is the largest single funder of the Cochrane PaPaS Group. Disclaimer: The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR, National Health Service (NHS), or the Department of Health.

Version history

Published

Title

Stage

Authors

Version

2016 Oct 17

Neuromuscular electrical stimulation for muscle weakness in adults with advanced disease

Review

Sarah Jones, William D‐C Man, Wei Gao, Irene J Higginson, Andrew Wilcock, Matthew Maddocks

https://doi.org/10.1002/14651858.CD009419.pub3

2013 Jan 31

Neuromuscular electrical stimulation for muscle weakness in adults with advanced disease

Review

Matthew Maddocks, Wei Gao, Irene J Higginson, Andrew Wilcock

https://doi.org/10.1002/14651858.CD009419.pub2

2011 Nov 09

Neuromuscular electrical stimulation for muscle weakness in adults with advanced disease

Protocol

Matthew Maddocks, Wei Gao, Irene J Higginson, Andrew Wilcock

https://doi.org/10.1002/14651858.CD009419

Differences between protocol and review

In this 2016 updated review we considered study size as a new 'Risk of bias' item to check for possible bias from small study size. We also included GRADE assessments of the quality of the evidence and added a 'Summary of findings' table. We did not include studies examining the acute effects of NMES following a single session.

Notes

A new search within two years is not likely to identify any potentially relevant studies likely to change the conclusions. Therefore, this review has now been stabilised following discussion with the authors and editors. The review will be re‐assessed for updating in five years. If appropriate, we will update the review before this date if new evidence likely to change the conclusions is published, or if standards change substantially which necessitate major revisions.

Keywords

MeSH

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 3

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

Forest plot of quadriceps muscle strength for NMES versus control.
Figuras y tablas -
Figure 4

Forest plot of quadriceps muscle strength for NMES versus control.

Forest plot of muscle mass for NMES versus control.
Figuras y tablas -
Figure 5

Forest plot of muscle mass for NMES versus control.

Forest plot of exercise performance for NMES versus control.
Figuras y tablas -
Figure 6

Forest plot of exercise performance for NMES versus control.

Comparison 1 Neuromuscular electrical stimulation versus control, Outcome 1 Quadriceps muscle strength.
Figuras y tablas -
Analysis 1.1

Comparison 1 Neuromuscular electrical stimulation versus control, Outcome 1 Quadriceps muscle strength.

Comparison 1 Neuromuscular electrical stimulation versus control, Outcome 2 Muscle mass.
Figuras y tablas -
Analysis 1.2

Comparison 1 Neuromuscular electrical stimulation versus control, Outcome 2 Muscle mass.

Comparison 1 Neuromuscular electrical stimulation versus control, Outcome 3 Exercise performance.
Figuras y tablas -
Analysis 1.3

Comparison 1 Neuromuscular electrical stimulation versus control, Outcome 3 Exercise performance.

Summary of findings for the main comparison. Neuromuscular electrical stimulation (NMES) versus control for adults with advanced disease for muscle weakness

NMES for adults with advanced disease for muscle weakness

Patient or population: adults with advanced disease for muscle weakness
Settings: hospital, community, or home settings
Intervention: NMES

Control: no intervention (7 studies), placebo NMES (8 studies), or resistance training (1 study)

Outcomes

Illustrative comparative risks* (95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

Control

NMES

Quadriceps muscle strength
Handheld or fixed dynamometry
Follow‐up: median 6 weeks

The mean change was 0.43 standard deviations from baseline.

The mean change in the intervention groups was 0.53 standard deviations higher (ranging from 0.19 to 0.87 standard deviations higher).

781
(12 studies)

⊕⊕⊝⊝
low1,2

Safety
Serious adverse events
Follow‐up: median 6 weeks

No serious adverse events related to control interventions reported.

No serious adverse events related to NMES reported.

933
(18 studies)

⊕⊕⊕⊝
moderate3

Safety

Adverse events: Muscle discomfort
Follow‐up: median 6 weeks

0/415 (0%) participants reported muscle discomfort following control interventions.

19/518 (3.7%) participants reported muscle discomfort following NMES.

933

(18 studies)

⊕⊕⊕⊝
moderate3

Muscle mass
Anthropometry, DEXA, ultrasound, computed tomography
Follow‐up: 4 to 9 weeks

The mean change in muscle mass ranged from 0.04 to 0.49 standard deviations from baseline across the different assessment modalities used.

The mean change in muscle mass ranged from 0.09 to 1.01 standard deviations higher across the different assessment modalities used.

314
(8 studies)

⊕⊝⊝⊝
very low4,5,6,7

Exercise performance ‐ walking distance
6MWT, ISWT, ESWT
Follow‐up: median 6 weeks

The mean change in distance walked was 21, 36, and 37 metres from baseline across the different walking tests used.

The mean change in distance walked was 35, 9, and 64 metres further across the different walking tests used.

788
(13 studies)

⊕⊝⊝⊝
very low2,7,8,9

Exercise performance ‐ peak oxygen uptake
Follow‐up: median 6 weeks

The mean change in peak oxygen uptake was ‐0.4 mL/min from baseline.

The mean exercise performance ‐ peak oxygen uptake in the intervention groups was 44.8 mL/min higher (95% CI 7.3 lower to 97.0 higher)

109
(4 studies)

⊕⊕⊝⊝
low7,9

*The basis for the assumed risk is the mean change from baseline in the control groups. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
6MWT: 6‐minute walk test; CI: confidence interval; DEXA: dual energy X‐ray absorptiometry; ESWT: endurance shuttle walk test; ISWT: incremental shuttle walk test

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1Downgraded once: the lower 95% CI for the estimate of effect was below what would be considered a small effect (standardised mean difference 0.2).
2Downgraded once: statistical tests indicated a high degree of heterogeneity; I2 values > 0.5.
3Downgraded once: small population size and limitations in reporting of safety data collection.
4Downgraded once: the estimate of effect for this outcome was inconsistent across different assessment modalities.
5Downgraded once: either study participants or outcome assessors were not blinded, but the outcome being assessed was non‐volitional.
6Downgraded once: findings derived from computed tomography were from a single study.
7Downgraded once: wide variance of point estimates, and inconsistency regarding the direction of an effect or whether or not there is an effect.
8Downgraded once: the lower 95% CI for the effect estimate for the 6MWT was below the established minimally important difference.
9Downgraded once: either study participants or outcome assessors were not blinded, and the outcome being assessed was volitional.

Figuras y tablas -
Summary of findings for the main comparison. Neuromuscular electrical stimulation (NMES) versus control for adults with advanced disease for muscle weakness
Comparison 1. Neuromuscular electrical stimulation versus control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Quadriceps muscle strength Show forest plot

12

781

Std. Mean Difference (IV, Random, 95% CI)

0.53 [0.19, 0.87]

2 Muscle mass Show forest plot

8

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 Anthropometry

2

31

Std. Mean Difference (IV, Random, 95% CI)

0.69 [‐0.05, 1.42]

2.2 Dual energy X‐ray absorptiometry (DEXA)

3

179

Std. Mean Difference (IV, Random, 95% CI)

0.09 [‐0.20, 0.38]

2.3 Ultrasound

1

52

Std. Mean Difference (IV, Random, 95% CI)

0.82 [0.26, 1.39]

2.4 Computed tomography

2

52

Std. Mean Difference (IV, Random, 95% CI)

1.01 [0.42, 1.60]

3 Exercise performance Show forest plot

13

Mean Difference (IV, Random, 95% CI)

Subtotals only

3.1 6‐minute walk test (m) (6MWT)

7

317

Mean Difference (IV, Random, 95% CI)

34.78 [13.52, 56.05]

3.2 Incremental shuttle walk test (m) (ISWT)

3

434

Mean Difference (IV, Random, 95% CI)

8.72 [‐34.87, 52.31]

3.3 Endurance shuttle walk test (m) (ESWT)

4

452

Mean Difference (IV, Random, 95% CI)

64.13 [‐17.79, 146.05]

3.4 Cardiopulmonary exercise testing (mL/min) (CPET)

4

109

Mean Difference (IV, Random, 95% CI)

44.82 [‐7.34, 96.99]

Figuras y tablas -
Comparison 1. Neuromuscular electrical stimulation versus control