Effectiveness of functional electrical stimulation in improving clinical outcomes in the upper arm following stroke: a systematic review and meta-analysis

Amir K Vafadar, Julie N Côté, Philippe S Archambault, Amir K Vafadar, Julie N Côté, Philippe S Archambault

Abstract

Background: Different therapeutic methods are being used to prevent or decrease long-term impairments of the upper arm in stroke patients. Functional electrical stimulation (FES) is one of these methods, which aims to stimulate the nerves of the weakened muscles so that the resulting muscle contractions resemble those of a functional task.

Objectives: The objective of this study was to review the evidence for the effect of FES on (1) shoulder subluxation, (2) pain, and (3) upper arm motor function in stroke patients, when added to conventional therapy.

Methods: From the 727 retrieved articles, 10 (9 RCTs, 1 quasi-RCT) were selected for final analysis and were rated based on the PEDro (Physiotherapy Evidence Database) scores and the Sackett's levels of evidence. A meta-analysis was performed for all three considered outcomes.

Results: The results of the meta-analyses showed a significant difference in shoulder subluxation in experimental groups compared to control groups, only if FES was applied early after stroke. No effects were found on pain or motor function outcomes.

Conclusion: FES can be used to prevent or reduce shoulder subluxation early after stroke. However, it should not be used to reduce pain or improve upper arm motor function after stroke.

Figures

Figure 1
Figure 1
Flowchart of database search and article selection process.
Figure 2
Figure 2
Effect of FES on shoulder subluxation “early” after stroke, with data pooled from 6 articles. CI = confidence interval, SD = standard deviation.
Figure 3
Figure 3
Effect of FES on shoulder subluxation “late” after stroke, with data pooled from 2 articles. CI = confidence interval, SD = standard deviation.
Figure 4
Figure 4
Effect of FES on shoulder pain “early” after stroke, measured as pain-free range of lateral rotation, with data pooled from 3 articles. CI = confidence interval, SD = standard deviation.
Figure 5
Figure 5
Effect of FES on shoulder pain “early” after stroke, measured with pain numeric scales, with data pooled from 3 articles. CI = confidence interval, SD = standard deviation.
Figure 6
Figure 6
Effect of FES on motor function “early” after stroke, measured with assessment scales, with data pooled from 5 articles. CI = confidence interval, SD = standard deviation.

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Source: PubMed

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