Shishi Chen, Jingjing Gao, Ye Zhou, Beisi Zheng, Yuxiang Liu, Manting Cao, Haiping Huang, Xinyi Su, Jianer Chen
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PubMed, Cochrane Library, Embase, Science Direct and Web of Science were systematically searched until April 2024, to identify randomized controlled trials with the following criteria: stroke survivors as participants; NMES as intervention; conventional rehabilitation as a comparator; and gait assessment, through scales or quantitative parameters, as outcome measures. 29 publications involving 1711 patients met the inclusion criteria. Meta-analysis showed no significant differences in Ten-meter walk test, Fugl-Meyer assessment lower extremity, Modified Ashworth Assessment and asymmetry between the NMES group and the control group. Besides, NMES was associated with changes in outcome indicators such as quantitative gait analysis speed [SMD = 0.53, 95% CI (0.20, 0.85), P = 0.001], cadence [SMD = 0.76, 95% CI (0.32, 1.20), P = 0.0008], affected side step length [SMD = 0.73, 95% CI (0.16, 1.31), P = 0.01], angle of ankle dorsiflexion [WMD = 1.57, 95% CI (0.80, 2.33), P < 0.0001], Six-Minute Walk Test [WMD = 14.83, 95% CI (13.55, 16.11), P<0.00001]. According to the PEDro scale, 21 (72.4%) studies were of high quality and 8 were of moderate quality (27.6%). Taken together, the review synthesis indicated that NMES might play a potential role in stroke-induced walking dysfunction. And NMES may be superior for survivors in the chronic phase than the acute and subacute phases, and the efficacy of short sessions received by patients was greater than that of those who participated in a longer session. Additionally, further comparisons of the effects of NMES with different types or stimulation frequencies may provide unexpected benefits.","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":"7 1","pages":""},"PeriodicalIF":5.2000,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Implications of neuromuscular electrical stimulation on gait ability, balance and kinematic parameters after stroke: a systematic review and meta-analysis\",\"authors\":\"Shishi Chen, Jingjing Gao, Ye Zhou, Beisi Zheng, Yuxiang Liu, Manting Cao, Haiping Huang, Xinyi Su, Jianer Chen\",\"doi\":\"10.1186/s12984-024-01462-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Improper gait patterns, impaired balance and foot drop consistently plague stroke survivors, preventing them from walking independently and safely. Neuromuscular electrical stimulation (NMES) technology can help patients reactivate their muscles and regain motor coordination. This study aims to systematically review and summarize the evidence for the potential benefits of NMES on the improvement of gait patterns after stroke. PubMed, Cochrane Library, Embase, Science Direct and Web of Science were systematically searched until April 2024, to identify randomized controlled trials with the following criteria: stroke survivors as participants; NMES as intervention; conventional rehabilitation as a comparator; and gait assessment, through scales or quantitative parameters, as outcome measures. 29 publications involving 1711 patients met the inclusion criteria. Meta-analysis showed no significant differences in Ten-meter walk test, Fugl-Meyer assessment lower extremity, Modified Ashworth Assessment and asymmetry between the NMES group and the control group. Besides, NMES was associated with changes in outcome indicators such as quantitative gait analysis speed [SMD = 0.53, 95% CI (0.20, 0.85), P = 0.001], cadence [SMD = 0.76, 95% CI (0.32, 1.20), P = 0.0008], affected side step length [SMD = 0.73, 95% CI (0.16, 1.31), P = 0.01], angle of ankle dorsiflexion [WMD = 1.57, 95% CI (0.80, 2.33), P < 0.0001], Six-Minute Walk Test [WMD = 14.83, 95% CI (13.55, 16.11), P<0.00001]. According to the PEDro scale, 21 (72.4%) studies were of high quality and 8 were of moderate quality (27.6%). Taken together, the review synthesis indicated that NMES might play a potential role in stroke-induced walking dysfunction. And NMES may be superior for survivors in the chronic phase than the acute and subacute phases, and the efficacy of short sessions received by patients was greater than that of those who participated in a longer session. 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引用次数: 0
摘要
步态不正确、平衡能力受损和足下垂一直困扰着中风患者,使他们无法独立、安全地行走。神经肌肉电刺激(NMES)技术可以帮助患者重新激活肌肉,恢复运动协调能力。本研究旨在系统回顾和总结 NMES 对改善中风后步态的潜在益处的证据。在 2024 年 4 月之前,对 PubMed、Cochrane Library、Embase、Science Direct 和 Web of Science 进行了系统检索,以确定符合以下标准的随机对照试验:以中风幸存者为参与者;以 NMES 为干预措施;以常规康复为比较对象;以通过量表或定量参数进行的步态评估为结果测量指标。符合纳入标准的出版物有 29 篇,涉及 1711 名患者。Meta 分析表明,NMES 组与对照组在十米步行测试、下肢 Fugl-Meyer 评估、改良 Ashworth 评估和不对称方面无明显差异。此外,NMES 与定量步态分析速度[SMD = 0.53,95% CI (0.20,0.85),P = 0.001]、步幅[SMD = 0.76,95% CI (0.32,1.20),P = 0.001]、受影响侧步长[SMD = 0.001,95% CI (0.32,1.20),P = 0.001]等结果指标的变化相关。0008]、患侧步长[SMD=0.73,95% CI(0.16,1.31),P=0.01]、踝关节背屈角度[WMD=1.57,95% CI(0.80,2.33),P<0.0001]、六分钟步行测试[WMD=14.83,95% CI(13.55,16.11),P<0.00001]。根据 PEDro 量表,21 项研究(72.4%)为高质量,8 项为中等质量(27.6%)。综上所述,综述表明,NMES 可能在中风引起的行走功能障碍中发挥潜在作用。而且,NMES 对慢性期幸存者的疗效可能优于急性期和亚急性期,患者接受短期疗程的疗效优于参加长期疗程的疗效。此外,进一步比较不同类型或刺激频率的 NMES 效果可能会带来意想不到的益处。
Implications of neuromuscular electrical stimulation on gait ability, balance and kinematic parameters after stroke: a systematic review and meta-analysis
Improper gait patterns, impaired balance and foot drop consistently plague stroke survivors, preventing them from walking independently and safely. Neuromuscular electrical stimulation (NMES) technology can help patients reactivate their muscles and regain motor coordination. This study aims to systematically review and summarize the evidence for the potential benefits of NMES on the improvement of gait patterns after stroke. PubMed, Cochrane Library, Embase, Science Direct and Web of Science were systematically searched until April 2024, to identify randomized controlled trials with the following criteria: stroke survivors as participants; NMES as intervention; conventional rehabilitation as a comparator; and gait assessment, through scales or quantitative parameters, as outcome measures. 29 publications involving 1711 patients met the inclusion criteria. Meta-analysis showed no significant differences in Ten-meter walk test, Fugl-Meyer assessment lower extremity, Modified Ashworth Assessment and asymmetry between the NMES group and the control group. Besides, NMES was associated with changes in outcome indicators such as quantitative gait analysis speed [SMD = 0.53, 95% CI (0.20, 0.85), P = 0.001], cadence [SMD = 0.76, 95% CI (0.32, 1.20), P = 0.0008], affected side step length [SMD = 0.73, 95% CI (0.16, 1.31), P = 0.01], angle of ankle dorsiflexion [WMD = 1.57, 95% CI (0.80, 2.33), P < 0.0001], Six-Minute Walk Test [WMD = 14.83, 95% CI (13.55, 16.11), P<0.00001]. According to the PEDro scale, 21 (72.4%) studies were of high quality and 8 were of moderate quality (27.6%). Taken together, the review synthesis indicated that NMES might play a potential role in stroke-induced walking dysfunction. And NMES may be superior for survivors in the chronic phase than the acute and subacute phases, and the efficacy of short sessions received by patients was greater than that of those who participated in a longer session. Additionally, further comparisons of the effects of NMES with different types or stimulation frequencies may provide unexpected benefits.
期刊介绍:
Journal of NeuroEngineering and Rehabilitation considers manuscripts on all aspects of research that result from cross-fertilization of the fields of neuroscience, biomedical engineering, and physical medicine & rehabilitation.