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Lo Re V, Russelli G, Lo Gerfo E, Alduino R, Bulati M, Iannolo G, Terzo D, Martucci G, Anzani S, Panarello G, Sparacia G, Parla G, Avorio F, Raffa G, Pilato M, Speciale A, Agnese V, Mamone G, Tuzzolino F, Vizzini GB, Conaldi PG, Ambrosio F. Cognitive outcomes in patients treated with neuromuscular electrical stimulation after coronary artery bypass grafting. Front Neurol 2023; 14:1209905. [PMID: 37693766 PMCID: PMC10486105 DOI: 10.3389/fneur.2023.1209905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023] Open
Abstract
Objective Mechanisms of neurocognitive injury as post-operative sequelae of coronary artery bypass grafting (CABG) are not understood. The systemic inflammatory response to surgical stress causes skeletal muscle impairment, and this is also worsened by immobility. Since evidence supports a link between muscle vitality and neuroprotection, there is a need to understand the mechanisms by which promotion of muscle activity counteracts the deleterious effects of surgery on long-term cognition. Methods We performed a clinical trial to test the hypothesis that adding neuromuscular electrical stimulation (NMES) to standard rehabilitation care in post-CABG patients promotes the maintenance of skeletal muscle strength and the expression of circulating neuroprotective myokines. Results We did not find higher serum levels of neuroprotective myokines, except for interleukin-6, nor better long-term cognitive performance in our intervention group. However, a greater increase in functional connectivity at brain magnetic resonance was seen between seed regions within the default mode, frontoparietal, salience, and sensorimotor networks in the NMES group. Regardless of the treatment protocol, patients with a Klotho increase 3 months after hospital discharge compared to baseline Klotho values showed better scores in delayed memory tests. Significance We confirm the potential neuroprotective effect of Klotho in a clinical setting and for the first time post-CABG.
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Affiliation(s)
- Vincenzina Lo Re
- Neurology Service, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), University of Pittsburgh Medical Center (UPMC), Palermo, Italy
| | | | - Emanuele Lo Gerfo
- Neurology Service, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), University of Pittsburgh Medical Center (UPMC), Palermo, Italy
- Department of Research, IRCCS ISMETT, UPMC, Palermo, Italy
| | | | - Matteo Bulati
- Department of Research, IRCCS ISMETT, UPMC, Palermo, Italy
| | | | - Danilo Terzo
- Rehabilitation Service, IRCCS ISMETT, Palermo, Italy
| | - Gennaro Martucci
- Department of Anesthesiology and Intensive Care, IRCCS ISMETT, UPMC, Palermo, Italy
| | - Stefano Anzani
- Neurology Service, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), University of Pittsburgh Medical Center (UPMC), Palermo, Italy
- Department of Research, IRCCS ISMETT, UPMC, Palermo, Italy
| | - Giovanna Panarello
- Department of Anesthesiology and Intensive Care, IRCCS ISMETT, UPMC, Palermo, Italy
| | - Gianvincenzo Sparacia
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT, Palermo, Italy
| | - Giuseppe Parla
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT, Palermo, Italy
| | - Federica Avorio
- Neurology Service, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), University of Pittsburgh Medical Center (UPMC), Palermo, Italy
| | - Giuseppe Raffa
- Cardiac Surgery Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT, Palermo, Italy
| | - Michele Pilato
- Cardiac Surgery Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS ISMETT, Palermo, Italy
| | | | | | - Giuseppe Mamone
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT, Palermo, Italy
| | | | | | | | - Fabrisia Ambrosio
- Discovery Center for Musculoskeletal Recovery, Schoen Adams Research Institute at Spaulding, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
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Verceles AC, Serra M, Davis D, Alon G, Wells CL, Parker E, Sorkin J, Bhatti W, Terrin ML. Combining exercise, protein supplementation and electric stimulation to mitigate muscle wasting and improve outcomes for survivors of critical illness-The ExPrES study. Heart Lung 2023; 58:229-235. [PMID: 36473808 PMCID: PMC9992240 DOI: 10.1016/j.hrtlng.2022.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Neuromuscular electrical stimulation (NMES) with high protein supplementation (HPRO) to preserve muscle mass and function has not been assessed in ICU patients. We compared the effects of combining NMES and HPRO with mobility and strength rehabilitation (NMES+HPRO+PT) to standardized ICU care. OBJECTIVES To assess the effectiveness of combined NMES+HPRO+PT in mitigating sarcopenia as evidenced by CT volume and cross-sectional area when compared to usual ICU care. Additionally, we assessed the effects of the combined therapy on select clinical outcomes, including nutritional status, nitrogen balance, delirium and days on mechanical ventilation. METHODS Participants were randomized by computer generated assignments to receive either NMES+HPRO+PT or standard care. Over 14 days the standardized ICU care group (N = 23) received usual critical care and rehabilitation while the NMES+HPRO+PT group (N = 16) received 30 min neuromuscular electrical stimulation of quadriceps and dorsiflexors twice-daily for 10 days and mean 1.3 ± 0.4 g/kg body weight of high protein supplementation in addition to standard care. Nonresponsive participants received passive exercises and, once responsive, were encouraged to exercise actively. Primary outcome measures were muscle volume and cross-sectional area measured using CT-imaging. Secondary outcomes included nutritional status, nitrogen balance, delirium and days on mechanical ventilation. RESULTS The NMES+HPRO+PT group (N = 16) lost less lower extremity muscle volume compared to the standard care group (N = 23) and had larger mean combined thigh cross-sectional area. The nitrogen balance remained negative in the standard care group, while positive on days 5, 9, and 14 in the NMES+HPRO+PT group. Standard care group participants experienced more delirium than the NMES+HPRO+PT group. No differences between groups when comparing length of stay or mechanical ventilation days. CONCLUSIONS The combination of neuromuscular electrical stimulation, high protein supplementation and mobility and strength rehabilitation resulted in mitigation of lower extremity muscle loss and less delirium in mechanically ventilated ICU patients. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT02509520. Registered July 28, 2015.
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Affiliation(s)
- Avelino C Verceles
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Monica Serra
- Department of Medicine, Division of Geriatrics, Gerontology & Palliative Medicine, Sam and Ann Barshop Institute for Longevity and Aging Studies at University of Texas Health Science, San Antonio, TX, USA
| | - Derik Davis
- Division of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Gad Alon
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD
| | - Chris L Wells
- Department of Rehabilitation Services, University of Maryland Medical Center, Baltimore, MD, USA
| | - Elizabeth Parker
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD
| | - John Sorkin
- Department of Medicine, Division of Geriatrics and Palliative Medicine, University of Maryland School of Medicine, Baltimore MD, USA; Department of Veterans Affairs, Baltimore VA Maryland Health Care System, Geriatric Research, Education and Clinical Center, Baltimore, MD, USA
| | - Waqas Bhatti
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael L Terrin
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Sumin AN, Oleinik PA, Bezdenezhnykh AV, Bezdenezhnykh NA. Prehabilitation in Cardiovascular Surgery: The Effect of Neuromuscular Electrical Stimulation (Randomized Clinical Trial). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2678. [PMID: 36768044 PMCID: PMC9916173 DOI: 10.3390/ijerph20032678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE We aimed to determine the effects of prehabilitation with neuromuscular electrical stimulation (NMES) on muscle status and exercise capacity in patients before cardiac surgery. METHODS Preoperative elective cardiac surgery patients were randomly assigned to the NMES group or control group. Intervention in the NMES group was 7-10 sessions, whereas the control group carried out breathing exercises and an educational program. The outcome measures included a six-minute walk test (6MWT) and a muscle status assessment (knee extensor strength (KES), knee flexor strength (KFS), and handgrip strength (HS)) after the course of prehabilitation. RESULTS A total of 122 patients (NMES, n = 62; control, n = 60) completed the study. During the NMES course, no complications occurred. After the course prehabilitation KES, KFS, and 6MWT distance were significantly increased (all p < 0.001) in the NMES group compared to the control. There was no significant difference in HS before surgery. CONCLUSIONS A short-term NMES course before cardiac surgery is feasible, safe, and effective to improve preoperative functional capacity (six-minute walk distance) and the strength of stimulated muscles.
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Affiliation(s)
- Alexey N. Sumin
- Correspondence: ; Tel.: +7-(3842)-64-33-08 or +7-9039-40-86-68; Fax: (3842)-64-34-10
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Takino K, Kameshima M, Asai C, Kawamura I, Tomita S, Sato H, Hirakawa A, Yamada S. Neuromuscular electrical stimulation after cardiovascular surgery mitigates muscle weakness in older individuals with diabetes. Ann Phys Rehabil Med 2022; 66:101659. [PMID: 35272065 DOI: 10.1016/j.rehab.2022.101659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/18/2022] [Accepted: 01/25/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Cardiovascular surgery leads to postsurgical muscle weakness, probably because of muscle proteolysis and peripheral nerve dysfunction, which are augmented by aging and diabetes mellitus. OBJECTIVE We examined the effect of neuromuscular electrical stimulation (NMES) on postsurgical muscle weakness in older individuals with diabetes mellitus. METHODS We conducted a multicentre, randomized, controlled trial, and screened consecutive patients with diabetes who underwent cardiovascular surgery for eligibility (age ≥ 65 years). Those included were randomly assigned to the NMES or the sham group. The primary outcome was the percent change in isometric knee extension strength (%ΔIKES) from preoperative to postoperative day 7. Secondary outcomes were the percent change in usual (%ΔUWS), maximum walking speed (%ΔMWS), and grip strength (%ΔGS). A statistician who was blinded to group allocation used intention-to-treat analysis (student t test). RESULTS Of 1151 participants screened for eligibility, 180 (NMES, n = 90; sham, n = 90) were included in the primary analysis. %ΔIKES was significantly lower in the NMES than sham group (NMES: mean -2%, 95% confidence interval [CI] -6 to 1; sham: -13%, 95% CI -17 to -9, p < 0.001). Among the secondary outcomes, %ΔMWS was significantly lower and %ΔUWS and %ΔGS were lower, although not significantly, in the NMES than sham group. CONCLUSIONS A short course of NMES (< 1 week) mitigated postsurgical muscle weakness and functional decline in older persons with diabetes mellitus. NMES could be recommended as a part of postsurgical rehabilitation in older people with diabetes mellitus, especially those with a low functional reserve.
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Affiliation(s)
- Koya Takino
- Department of Cardiac Rehabilitation, Gifu Heart Center, 4-14-4, Yabuta-minami, Gifu, Japan; Program in Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, Japan
| | - Masataka Kameshima
- Department of Cardiac Rehabilitation, Nagoya Heart Center, 1-1-11, Sunadabashi, higasi-ku, Nagoya, Japan
| | - Chikako Asai
- Department of Cardiac Rehabilitation, Toyohashi Heart Center, 1-21, Gobudori, Oyamacho, Toyohasi, Japan
| | - Itta Kawamura
- Department of Cardiology, Gifu Heart Center, 4-14-4, Yabuta-minami, Gifu, Japan
| | - Shinji Tomita
- Department of Cardiovascular Surgery, Gifu Heart Center, 4-14-4, Yabuta-minami, Gifu, Japan
| | - Hiroyuki Sato
- Division of Biostatistics and Data Science, Clinical Research Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Akihiro Hirakawa
- Division of Biostatistics and Data Science, Clinical Research Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Sumio Yamada
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya, Japan.
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Efthimiou TN, Hanel PHP, Korb S. Volunteers' concerns about facial neuromuscular electrical stimulation. BMC Psychol 2022; 10:117. [PMID: 35526073 PMCID: PMC9080168 DOI: 10.1186/s40359-022-00827-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
Facial neuromuscular electrical stimulation (NMES) is the application of an electrical current to the skin to induce muscle contractions and has enormous potential for basic research and clinical intervention in psychology and neuroscience. Because the technique remains largely unknown, and the prospect of receiving electricity to the face can be daunting, willingness to receive facial NMES is likely to be low and gender differences might exist in the amount of concern for the sensation of pain and skin burns. We investigated these questions in 182 healthy participants. The likelihood of taking part (LOTP) in a hypothetical facial NMES study was measured both before and after presenting a detailed vignette about facial NMES including its risks. Results showed that LOTP was generally high and that participants remained more likely to participate than not to, despite a decrease in LOTP after the detailed vignette. LOTP was significantly predicted by participants' previous knowledge about electrical stimulation and their tendency not to worry about the sensations of pain, and it was inversely related to concerns for burns and loss of muscle control. Fear of pain was also inversely related to LOTP, but its effect was mediated by the other concerns. We conclude that willingness to receive facial NMES is generally high across individuals in the studied age range (18-45) and that it is particularly important to reassure participants about facial NMES safety regarding burns and loss of muscle control. The findings are relevant for scholars considering using facial NMES in the laboratory.
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Affiliation(s)
| | - Paul H P Hanel
- Department of Psychology, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, UK
| | - Sebastian Korb
- Department of Psychology, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, UK.,Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Vienna, Austria
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Sumin AN, Oleinik PA, Bezdenezhnykh AV, Bezdenezhnykh NA. Factors Determining the Functional State of Cardiac Surgery Patients with Complicated Postoperative Period. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074329. [PMID: 35410009 PMCID: PMC8998976 DOI: 10.3390/ijerph19074329] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 02/01/2023]
Abstract
The purpose of this work was to study the factors determining the functional state of cardiac surgery patients with a complicated postoperative period upon discharge from the hospital. This observational study included 60 patients who underwent cardiac surgery with a complicated postoperative course and with a prolonged intensive care unit stay of more than 72 h. We assessed handgrip and lower-extremity muscle strength and the six-minute walk test (6MWT) distance 3 days after the surgery and at discharge from the hospital. Some patients (53%) additionally underwent a course of neuromuscular electrostimulation (NMES). Two groups of patients were formed: first (6MWT distance at discharge of more than 300 m) and second groups (6MWT distance of 300 m or less). The patients of the second group had less lower-extremity muscle strength and handgrip strength on the third postoperative day, a longer aortic clamping time and a longer stay in the intensive care unit. Independent predictors of decreased exercise tolerance at discharge were body mass index, foot extensor strength and baseline 6MWT distance in the general group, duration of cardiopulmonary bypass in the NMES group and in the general group, and age in the NMES group. Thus, the muscle status on the third postoperative day was one of the independent factors associated with the 6MWT distance at discharge in the general group, but not in patients who received NMES. It is advisable to use these results in patients with complications after cardiac surgery with the use of NMES rehabilitation.
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Lawson DO, Mellor K, Eddy S, Lee C, Kim KH, Kim K, Mbuagbaw L, Thabane L. Pilot and Feasibility Studies in Rehabilitation Research: A Review and Educational Primer for the Physiatrist Researcher. Am J Phys Med Rehabil 2022; 101:372-383. [PMID: 34091466 DOI: 10.1097/phm.0000000000001797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Pilot and feasibility studies are conducted early in the clinical research pathway to evaluate whether a future, definitive study can or should be done and, if so, how. Poor planning and reporting of pilot and feasibility studies can compromise subsequent research efforts. Inappropriate labeling of studies as pilots also compromises education. In this review, first, a systematic survey of the current state of pilot and feasibility studies in rehabilitation research was performed, and second, recommendations were made for improvements to their design and reporting. In a random sample of 100 studies, half (49.5%) were randomized trials. Thirty (30.0%) and three (3.0%) studies used "pilot" and "feasibility" in the study title, respectively. Only one third (34.0%) of studies provided a primary objective related to feasibility. Most studies (92.0%) stated an intent for hypothesis testing. Although many studies (70.0%) mentioned outcomes related to feasibility in the methods, a third (30.0%) reported additional outcomes in the results and discussion only or commented on feasibility anecdotally. The reporting of progression plans to a main study (21.0%) and progression criteria (4.0%) was infrequent. Based on these findings, it is recommended that researchers correctly label studies as a pilot or feasibility design based on accepted definitions, explicitly state feasibility objectives, outcomes, and criteria for determining success of feasibility, justify the sample size, and appropriately interpret and report the implications of feasibility findings for the main future study.
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Affiliation(s)
- Daeria O Lawson
- From the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (DOL, LM, LT); Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom (KM); Institute of Population Health Sciences, Queen Mary University of London, London, United Kingdom (SE); Department of Medicine, McMaster University, Hamilton, Ontario, Canada (CL, KHK, KK); and Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada (LM, LT)
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Immediate Hemodynamic Responses to Transcutaneous Electrical Diaphragmatic Stimulation in Critically Ill Elderly Patients. Rehabil Res Pract 2022; 2021:9091278. [PMID: 34976410 PMCID: PMC8716245 DOI: 10.1155/2021/9091278] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/20/2021] [Accepted: 12/06/2021] [Indexed: 12/04/2022] Open
Abstract
Background Critically ill patients admitted to intensive care units (ICUs) may develop diaphragmatic dysfunction, especially when artificial airways are used. Positive effects have been observed when using the transcutaneous electrical diaphragmatic stimulation (TEDS) technique in different clinical conditions. However, no study has evaluated the safety of TEDS in patients admitted to ICUs. This study is aimed at evaluating the influence of TEDS on the hemodynamic and vital parameters of critically ill elderly patients under invasive mechanical ventilation (IMV). Methods Forty-seven patients aged >60 years under IMV were evaluated for hemodynamic variables before and after TEDS. The procedure lasted 30 minutes and was performed once. Results The sample consisted of 33 men and 14 women with a mean age of 69.9 ± 7.64 years. The mean systolic blood pressures pre-TEDS and post-TEDS were 126.6 ± 23.7 and 122.9 ± 25.9, respectively (p = 0.467). The mean diastolic blood pressures pre-TEDS and post-TEDS were 71.1 ± 12.2 and 67.7 ± 14.2, respectively (p = 0.223). No significant differences in the mean arterial pressure or heart rate were found between the pre-TEDS and post-TEDS time points (p = 0.335 and p = 0.846, respectively). Conclusion Our findings suggest that TEDS does not have clinically relevant impacts on hemodynamic or vital parameters in critically ill elderly patients. These findings point to the possible safety of TEDS application in this population.
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Cerqueira TCF, de Cerqueira Neto ML, Cacau LDAP, de Araújo Filho AA, Oliveira GU, da Silva Júnior WM, Carvalho VO, de Mendonça JT, de Santana Filho VJ. Effect of neuromuscular electrical stimulation on functional exercise capacity in patients undergoing cardiac surgery: A randomized clinical trial. Clin Rehabil 2021; 36:789-800. [PMID: 34971331 DOI: 10.1177/02692155211070945] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the effects of neuromuscular electrical stimulation on functional capacity of patients in the immediate postoperative period of cardiac surgery. DESIGN A prospective, randomized controlled trial. SETTING A cardiac surgery specialist hospital in Aracaju, Sergipe, Brazil. Subjects: Patients in the postoperative period of cardiac surgery. INTERVENTION The control group received the conventional physiotherapy and the intervention group received neuromuscular electrical stimulation of the rectus femoris and gastrocnemius muscles bilaterally, applied for 60 min, twice a day for up to 10 sessions per patient, in the immediate postoperative period until postoperative day 5. MAIN MEASURES The primary outcome was the distance walked, which was evaluated using the 6-min walk test on postoperative day 5. Secondary outcomes were gait speed, lactate levels, muscle strength, electromyographic activity of the rectus femoris and Functional Independence Measure, some of them evaluated on preoperative and postoperative period. RESULTS Of 132 eligible patients, 88 patients were included and randomly allocated in two groups, and 45 patients were included in the analysis. No significant difference was found on the distance walked (p = 0.650) between patients allocated in intervention group (239.06 ± 88.55) and control group (254.43 ± 116.67) as well as gait speed (p = 0.363), lactate levels (p = 0.302), knee extensor strength (p = 0.117), handgrip strength (p = 0.882), global muscle strength (p = 0.104), electromyographic activity (p = 0.179) and Functional Independence Measure (p = 0.059). CONCLUSIONS Although the effects are still uncertain, the use of neuromuscular electrical stimulation carried out in five days didn't present any benefit on functional capacity of patients in the immediate postoperative period of cardiac surgery.
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Tajima H, Matsuse H, Hashida R, Nago T, Bekki M, Iwanaga S, Higashi E, Shiba N. Electrically stimulated eccentric contraction during non-weight bearing knee bending exercise in the supine position increases oxygen uptake: A randomized, controlled, exploratory crossover trial. PLoS One 2021; 16:e0259856. [PMID: 34793521 PMCID: PMC8601547 DOI: 10.1371/journal.pone.0259856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/24/2021] [Indexed: 12/02/2022] Open
Abstract
It is well known that prolonged bed rest induces muscle weakness, muscle atrophy, cardiovascular deconditioning, bone loss, a loss of functional capacity, and the development of insulin resistance. Neuromuscular electrical stimulation is anticipated to be an interventional strategy for disuse due to bed rest. A hybrid training system (HTS), synchronized neuromuscular electrical stimulation for voluntary exercise using an articular motion sensor, may increase the exercise load though bed rest. We assessed oxygen uptake or heart rate during knee bending exercise in the supine position on a bed both simultaneously combined with HTS and without HTS to evaluate exercise intensity on different days in ten healthy subjects (8 men and 2 women) by a randomized controlled crossover trial. The values of relative oxygen uptake during knee bending exercise with HTS were significantly greater than those during knee bending exercise without HTS (7.29 ± 0.91 ml/kg/min vs. 8.29 ± 1.06 ml/kg/min; p = 0.0115). That increment with HTS was a mean of 14.42 ± 13.99%. Metabolic equivalents during knee bending exercise with HTS and without HTS were 2.08 ± 0.26 and 2.39 ± 0.30, respectively. The values of heart rate during knee bending exercise with HTS were significantly greater than those during knee bending exercise without HTS (80.82 ± 9.19 bpm vs. 86.36 ± 5.50 bpm; p = 0.0153). HTS could increase exercise load during knee bending exercise which is easy to implement on a bed. HTS might be a useful technique as a countermeasure against the disuse due to bed rest, for example during acute care or the quarantine for infection prophylaxis.
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Affiliation(s)
- Hiroshi Tajima
- Rehabilitation Center, Kurume University, Kurume, Fukuoka, Japan
| | - Hiroo Matsuse
- Rehabilitation Center, Kurume University, Kurume, Fukuoka, Japan
- * E-mail:
| | - Ryuki Hashida
- Rehabilitation Center, Kurume University, Kurume, Fukuoka, Japan
| | - Takeshi Nago
- Rehabilitation Center, Kurume University, Kurume, Fukuoka, Japan
| | - Masafumi Bekki
- Rehabilitation Center, Kurume University, Kurume, Fukuoka, Japan
| | - Sohei Iwanaga
- Rehabilitation Center, Kurume University, Kurume, Fukuoka, Japan
| | - Eriko Higashi
- Rehabilitation Center, Kurume University, Kurume, Fukuoka, Japan
| | - Naoto Shiba
- Rehabilitation Center, Kurume University, Kurume, Fukuoka, Japan
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Zhang X, Peng Y, Zhong F, Li S, Huang X, Huang Q, Chen L, Lin Y. Effects of neuromuscular electrical stimulation on functional capacity and quality of life among patients after cardiac surgery: A systematic review and meta-analysis. J Cardiol 2021; 79:291-298. [PMID: 34657773 DOI: 10.1016/j.jjcc.2021.09.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/03/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Neuromuscular electrical stimulation (NMES) is a possible adjunctive therapy applied to cardiac surgery patients to improve physical function, but the results are still controversial. A systematic review and meta-analysis was conducted to investigate the effects of NMES on functional capacity and quality of life (QoL) in cardiac surgery patients. METHODS The following databases PubMed, Embase, Medicine, CINAHL, and the Cochrane Central Register of Controlled Trials were searched for the English language from inception up to March 2021. A systematic targeted literature search evaluating the effects of NMES on physical function and QoL in cardiac surgery patients. The effect size of NMES was presented as the mean difference (MD)/standardized mean difference (SMD) and its 95% confidence interval using fixed/random effect models according to heterogeneity. Two reviewers independently screened and appraised each study by using the Cochrane Risk of Bias Tool. RESULTS Six studies were included involving 400 cardiac surgery patients. The meta-analysis showed that NMES had effect on knee extensor strength (SMD=1.68; p=0.05), but had no effects on 6-minute walking distance (MD=44.08; p=0.22), walking speed (MD=0.05; p=0.24), grip strength (MD=3.01; p=0.39), or QoL (SMD=0.53; p=0.19). CONCLUSIONS NMES use in cardiac surgery patients is limited by low to moderate quality. Existing evidence shows that NMES is safe and effective for improving knee extensor strength.
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Affiliation(s)
- Xu Zhang
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Yanchun Peng
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Fuxiu Zhong
- Department of Nursing, Fujian Medical University Union Hospital, Fuzhou, China
| | - Sailan Li
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xizhen Huang
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qubo Huang
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Liangwan Chen
- Department of Cardiac Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Fujian Heart Medicine Research Center, Fuzhou, China.
| | - Yanjuan Lin
- Department of Nursing, Fujian Medical University Union Hospital, Fuzhou, China; Fujian Heart Medicine Research Center, Fuzhou, China.
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12
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Corbin GN, Weaver K, Dolbow DR, Credeur D, Pattanaik S, Stokic DS. Safety and preliminary efficacy of functional electrical stimulation cycling in an individual with cervical cord injury, autonomic dysreflexia, and a pacemaker: Case report. J Spinal Cord Med 2021; 44:613-616. [PMID: 31809247 PMCID: PMC8288131 DOI: 10.1080/10790268.2019.1692180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Context: Functional electric stimulation (FES) cycling is a commonly used therapeutic exercise modality after spinal cord injury (SCI); however, additional precautions must be taken in certain situations. The purpose of this study was to develop and apply a safety monitoring protocol for autonomic dysreflexia (AD) during FES cycling and to determine if an interval-FES cycling program can be safe and beneficial to an individual with cervical SCI, a history of AD, and a non-dependent cardiac pacemaker.The participant was a 36-year-old male with C6 AIS-C SCI sustained 9 years earlier, intermittent AD, and implanted cardiac pacemaker. Ten sessions of interval-FES cycling were performed twice weekly for 5 weeks. Rating of perceived exertion (RPE), blood pressure (BP), oxygen saturation (O2sat), and heart rate (HR) were monitored before, after, and every 5 min during cycling. ECG and cardiac pacemaker were evaluated by a cardiologist after ending the program.Findings: The participant reported self-limited chills 27 times over 10 sessions (19 "light", 3 "moderate", 5 "sharp"). Chills coincided with BP increases 59% of the time and their magnitudes moderately correlated (r = 0.32). The ECG was determined to be normal and the pacemaker fully functional at the end of the study, while blood glucose decreased (111-105 mg/dl), HbA1c levels increased (5.5-5.9%), and resting BP decreased (118/84-108/66 mmHg).Conclusion/Clinical Relevance: A person with cervical SCI, symptomatic AD, and a non-dependent pacemaker can safely participate and benefit from the interval-FES cycling program provided adequate monitoring of symptoms and vital signs.
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Affiliation(s)
- Gevork N. Corbin
- School of Physical Therapy, Department of Biomedical Sciences, and College of Osteopathic Medicine, William Carey University, Hattiesburg, Mississippi, USA
| | - Kelsi Weaver
- School of Physical Therapy, Department of Biomedical Sciences, and College of Osteopathic Medicine, William Carey University, Hattiesburg, Mississippi, USA
| | - David R. Dolbow
- School of Physical Therapy, Department of Biomedical Sciences, and College of Osteopathic Medicine, William Carey University, Hattiesburg, Mississippi, USA,Correspondence to: David R. Dolbow, PT, DPT, PhD, RKT, Associate Professor, Physical Therapy Program, William Carey University, 710 William Carey Parkway, Hattiesburg, MS 39401, USA; Ph: 601-318-6274.
| | - Daniel Credeur
- School of Kinesiology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Sambit Pattanaik
- School of Physical Therapy, Department of Biomedical Sciences, and College of Osteopathic Medicine, William Carey University, Hattiesburg, Mississippi, USA
| | - Dobrivoje S. Stokic
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, Mississippi, USA
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13
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Nakanishi N, Takashima T, Oto J. Muscle atrophy in critically ill patients : a review of its cause, evaluation, and prevention. THE JOURNAL OF MEDICAL INVESTIGATION 2021; 67:1-10. [PMID: 32378591 DOI: 10.2152/jmi.67.1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Critically ill patients exhibit prominent muscle atrophy, which occurs rapidly after ICU admission and leads to poor clinical outcomes. The extent of atrophy differs among muscles as follows: upper limb: 0.7%-2.4% per day, lower limb: 1.2%-3.0% per day, and diaphragm 1.1%-10.9% per day. This atrophy is caused by numerous risk factors such as inflammation, immobilization, nutrition, hyperglycemia, medication, and mechanical ventilation. Muscle atrophy should be monitored noninvasively by ultrasound at the bedside. Ultrasound can assess muscle mass in most patients, although physical assessment is limited to almost half of all critically ill patients due to impaired consciousness. Important strategies to prevent muscle atrophy are physical therapy and electrical muscular stimulation. Electrical muscular stimulation is especially effective for patients with limited physical therapy. Regarding diaphragm atrophy, mechanical ventilation should be adjusted to maintain spontaneous breathing and titrate inspiratory pressure. However, the sufficient timing and amount of nutritional intervention remain unclear. Further investigation is necessary to prevent muscle atrophy and improve long-term outcomes. J. Med. Invest. 67 : 1-10, February, 2020.
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Affiliation(s)
- Nobuto Nakanishi
- Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima 770-8503, Japan
| | - Takuya Takashima
- Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima 770-8503, Japan
| | - Jun Oto
- Emergency and Disaster Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima 770-8503, Japan
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14
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de Macedo AC, Schein AS, Callegaro CC, Alves VM, Zambeli PM, Sbruzzi G, Schaan BD. Hemodynamic responses to neuromuscular electrical stimulation and to metaboreflex evaluation. J Sports Med Phys Fitness 2021; 62:163-169. [PMID: 33768772 DOI: 10.23736/s0022-4707.21.11877-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Metabolites produced during muscle exercise can sensitize types III and IV fibers, which account for increasing blood pressure (BP) and vascular resistance in non-exercising limbs, as well as for redistributing the blood flow to active muscles; reflex response is called metaboreflex. Neuromuscular electrical stimulation (NMES) induces greater local muscle metabolic demand than voluntary isometric contractions. Metabolic accumulation is essential to activate muscle metaboreflex; thus, the hypothesis of the current study is that one NMES session can induce metaboreflex with different hemodynamic responses in upper and lower limbs. Objective: investigating whether one acute NMES session could activate metaboreflex by inducing different hemodynamic responses between arms and legs. METHODS Twenty (20) healthy subjects (mean age = 47.7 ± 9.4 years, 13 women, mean body mass index = 26±3.4kg/m2) participated in this randomized crossover study. All participants were subjected to two NMES interventions, one in the upper limbs (UPL) and the other in the lower limbs (LL). Mean blood pressure (MBP), blood flow (BF) and vascular resistance (VR) at baseline were used to selectively evaluate metaboreflex responses during NMES interventions and recovery periods with, and without, postexercise circulatory occlusion (PECO+ and PECO-, respectively) through the area under the curve (AUC) in VR. RESULTS MBP increased by 13% during UPL interventions and only remained high during PECO+. Changes in MBP were not observed in LL, although BF in the contralateral leg has decreased by 14% during PECO+ protocol. Muscle metaboreflex activation (AUC differences in VR between PECO+ and PECO-) was not different between UPL and LL (p=0.655). CONCLUSIONS Acute NMES session has induced similar metaboreflex activation in both arms and legs, although hemodynamic responses differed between interventions.
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Affiliation(s)
- Aline C de Macedo
- Graduate Program in Health Sciences, Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Medical School, Porto Alegre, Brazil.,Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Physiopathology of Exercise Laboratory, Clinical Hospital of Porto Alegre, Porto Alegre, Brazil
| | - Andressa S Schein
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Physiopathology of Exercise Laboratory, Clinical Hospital of Porto Alegre, Porto Alegre, Brazil
| | - Carine C Callegaro
- Physiology and Rehabilitation Laboratory, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - Vinícius M Alves
- Physiopathology of Exercise Laboratory, Clinical Hospital of Porto Alegre, Porto Alegre, Brazil.,Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Paula M Zambeli
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Physiopathology of Exercise Laboratory, Clinical Hospital of Porto Alegre, Porto Alegre, Brazil
| | - Graciele Sbruzzi
- Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Physiopathology of Exercise Laboratory, Clinical Hospital of Porto Alegre, Porto Alegre, Brazil
| | - Beatriz D Schaan
- Graduate Program in Health Sciences, Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Medical School, Porto Alegre, Brazil - .,Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Physiopathology of Exercise Laboratory, Clinical Hospital of Porto Alegre, Porto Alegre, Brazil.,Internal Medicine Department, Graduate Program in Medical Sciences, Endocrinology, Medical School, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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15
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Neuromuscular Electrical Stimulation Improves Energy Substrate Metabolism and Survival in Mice With Acute Endotoxic Shock. Shock 2021; 53:236-241. [PMID: 31935202 PMCID: PMC6964866 DOI: 10.1097/shk.0000000000001354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study investigated the therapeutic benefits of neuromuscular electrical stimulation (NMES). C57BL/6 mice were administered lipopolysaccharide (LPS; 20 mg/kg body weight) by intraperitoneal injection and divided into control (C) and NMES groups (n = 10–12 each). The latter received NMES to the bilateral gastrocnemius muscle for 1 h at low or high frequency (LF = 2 Hz and HF = 50 Hz, respectively) and low or high voltage (LV = 10 V and HV = 50 V, respectively). In LF–LV and LF–HV groups, NMES was performed twice and the results were compared with those for mice that received one round of NMES. Changes in energy metabolism were measured by indirect calorimetry up to 24 h; survival was evaluated up to 72 h after LPS administration; peroxisome proliferator-activated receptor gamma coactivator (PGC)-1α expression in the liver and gastrocnemius muscle was evaluated by quantitative PCR; and plasma concentration of interleukin (IL)-6 was determined by enzyme-linked immunosorbent assay. Survival was improved only in the LF–LV group with one round of NMES (P < 0.01) and the LF–HV group with two rounds of NMES (P < 0.05). Fatty acid oxidation (FAO) was slightly increased in these two groups, whereas carbohydrate oxidation (CHO) was decreased or not changed. Significant upregulation of PGC-1α in muscle as well as a decrease in plasma IL-6 level were also observed in these two groups (P < 0.05). Thus, NMES exerts therapeutic effects under conditions that induce a mild switch in energy metabolism from glucose to lipid predominant metabolism through PGC-1α upregulation and suppression of inflammation, and may be an effective early intervention even in hemodynamically unstable patients.
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16
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Sandoval-Munoz CP, Haidar ZS. Neuro-Muscular Dentistry: the "diamond" concept of electro-stimulation potential for stomato-gnathic and oro-dental conditions. Head Face Med 2021; 17:2. [PMID: 33499906 PMCID: PMC7836574 DOI: 10.1186/s13005-021-00257-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 01/19/2021] [Indexed: 01/17/2023] Open
Abstract
Oro-Pharyngeal Dysphagia - or simply dysphagia - is the difficulty (persistent) in swallowing/passing food and/or liquid from the mouth to the pharynx into the esophagus and finally the stomach; a deglutition disorder (a symptom, by definition, often due to neuro-degenerative/−muscular, drug-induced or localized structural pathologies such as head and neck tumors, lesions and associated surgical and/or radiation injuries) linked to severe consequences on Quality of Life (QoL), including malnutrition, dehydration, and even sudden death. Likewise, Temporo-Mandibular Jaw and Joint disorder(s) – or simply TMD – is a multifactorial etiological condition, regularly encountered in the dental office. Whether due to malocclusion, bruxism, stress and/or trauma, TMD destabilizes the whole cranio-mandibular system structurally and functionally, via affecting mastication, teeth, supporting structures, comfort and aesthetics, and thus, QoL, again. While several treatment regimens do exist for such conditions, some of which have been standardized for use over the years, most continue to lack proper evidence-based literature support. Hence, (1) caution is to be exercised; and (2) the need for alternative therapeutic strategies is amplified, subsequently, the door for innovation is wide open. Indeed, neuromuscular electrical stimulation or “NMES”, is perhaps a fine example. Herein, we present the interested oro-dental health care provider with an up-dated revision of this therapeutic modality, its potential benefits, risks and concerns, to best handle the dysphagic patient: an intra-disciplinary approach or strategy bridging contemporary dentistry with speech and language therapy; a rather obscure and un-discovered yet critical allied health profession. A pre-clinical and clinical prospectus on employing inventive NMES-based regimens and devices to manage TMD is also highlighted.
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Affiliation(s)
- Catalina P Sandoval-Munoz
- BioMAT'X (Laboratorio de Biomateriales, Farmacéuticos y Bioingeniería de Tejidos Cráneo Máxilo-Facial), Universidad de los Andes, Mons. Álvaro del Portillo 12.455 - Las Condes, Santiago, Chile
| | - Ziyad S Haidar
- BioMAT'X (Laboratorio de Biomateriales, Farmacéuticos y Bioingeniería de Tejidos Cráneo Máxilo-Facial), Universidad de los Andes, Mons. Álvaro del Portillo 12.455 - Las Condes, Santiago, Chile. .,Programa de Doctorado en BioMedicina, Facultad de Medicina, Universidad de los Andes, Mons. Álvaro del Portillo 12.455 - Las Condes, Santiago, Chile. .,Centro de Investigación e Innovación Biomédica (CIIB), Universidad de los Andes, Mons. Álvaro del Portillo 12.455 - Las Condes, Santiago, Chile. .,Facultad de Odontología, Universidad de los Andes, Mons. Álvaro del Portillo 12.455 - Las Condes, Santiago, Chile.
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17
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Sumin AN, Oleinik PA, Bezdenezhnykh AV, Ivanova AV. Neuromuscular electrical stimulation in early rehabilitation of patients with postoperative complications after cardiovascular surgery: A randomized controlled trial. Medicine (Baltimore) 2020; 99:e22769. [PMID: 33080746 PMCID: PMC7572009 DOI: 10.1097/md.0000000000022769] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To evaluate the effectiveness of neuromuscular electrical stimulation (NMES) in early rehabilitation of patients with postoperative complications after cardiovascular surgery. METHODS 37 patients (25 men and 12 women) aged 45 to 70 years with postoperative complications after cardiovascular surgery were included in the study. Eighteen patients underwent NMES daily since postoperative day 3 until discharge in addition to standard rehabilitation program (NMES group), and 19 patients underwent standard rehabilitation program only (non-NMES group). The primary outcome was the knee extensors strength at discharge in NMES group and in control. Secondary outcomes were the handgrip strength, knee flexor strength, and cross-sectional area (CSA) of the quadriceps femoris in groups at discharge. RESULTS Baseline characteristics were not different between the groups. Knee extensors strength at discharge was significantly higher in the NMES group (28.1 [23.8; 36.2] kg on the right and 27.45 [22.3; 33.1] kg on the left) than in the non-NMES group (22.3 [20.1; 27.1] and 22.5 [20.1; 25.9] kg, respectively; P < .001). Handgrip strength, knee flexor strength, quadriceps CSA, and 6 minute walk distance at discharge in the groups had no significant difference. CONCLUSIONS This pilot study shows a beneficial effect of NMES on muscle strength in patients with complications after cardiovascular surgery. The use of NMES showed no effect on strength of non-stimulated muscle, quadriceps CSA, and distance of 6-minute walk test at discharge.Further blind randomized controlled trials should be performed with emphasis on the effectiveness of NEMS in increasing muscle strength and structure in these patients.
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18
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Kondo T, Yamada S, Tanimura D, Kazama S, Ishihara T, Shimojo M, Iwata E, Kondo S, Hiraiwa H, Kato T, Sano H, Awaji Y, Okumura T, Murohara T. Neuromuscular electrical stimulation is feasible in patients with acute heart failure. ESC Heart Fail 2019; 6:975-982. [PMID: 31461577 PMCID: PMC6816057 DOI: 10.1002/ehf2.12504] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/13/2019] [Accepted: 07/08/2019] [Indexed: 01/17/2023] Open
Abstract
Aims In acute heart failure (AHF), immobilization is caused because of unstable haemodynamics and dyspnoea, leading to protein wasting. Neuromuscular electrical stimulation (NMES) has been reported to preserve muscle mass and improve functional outcomes in chronic disease. NMES may be effective against protein wasting frequently manifested in patients with AHF; however, whether NMES can be implemented safely without any adverse effect on haemodynamics has remained unknown. This study aimed to examine the feasibility of NMES in patients with AHF. Methods and results Patients with AHF were randomly assigned to the NMES or control group. The intensity of the NMES group was set at 10–20% maximal voluntary contraction level, whereas the control group was limited at a visible or palpable level of muscle contraction. The sessions were performed 5 days per week since the day after admission. Before the study implementation, we set the feasibility criteria with following items: (i) change in systolic blood pressure (BP) > ±20 mmHg during the first session; (ii) increase in heart rate (HR) > +20 b.p.m. during the first session; (iii) development of sustained ventricular arrhythmia, atrial fibrillation (AF), and paroxysmal supraventricular tachycardia during all sessions; (iv) incidence of new‐onset AF during the hospitalization period < 40%; and (v) completion of the planned sessions by >70% of patients. The criteria of feasibility were set as follows; the percentage to fill one of (i)–(iii) was <20% of the total subjects, and both (iv) and (v) were satisfied. A total of 73 patients (median age 72 years, 51 men) who completed the first session were analysed (NMES group, n = 34; control group, n = 39). Systolic BP and HR variations were not significantly different between two groups (systolic BP, P = 0.958; HR, P = 0.665). Changes in BP > ±20 mmHg or HR > +20 b.p.m. were observed in three cases in the NMES group (8.8%) and five in the control group (12.8%). New‐onset arrhythmia was not observed during all sessions in both groups. During hospitalization, one patient newly developed AF in the NMES group (2.9%), and one developed AF (2.6%) and two lethal ventricular arrhythmia in the control group. Thirty‐one patients in the NMES group (91%) and 33 patients in the control group (84%) completed the planned sessions during hospitalization. This study fulfilled the preset feasibility criteria. Conclusions NMES is feasible in patients with AHF from immediately after admission.
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Affiliation(s)
- Toru Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sumio Yamada
- Department of Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daisuke Tanimura
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Shingo Kazama
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | | | - Masafumi Shimojo
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Etsuo Iwata
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sayano Kondo
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Hiroaki Hiraiwa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshiaki Kato
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Hiroaki Sano
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Yoshifumi Awaji
- Department of Cardiology, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Del Río Solá ML, Puerta CV. Effectiveness of the Combined Treatment of Functional Electrical Stimulation and Deambulation in Diabetic Arteriopathy. Ann Vasc Surg 2019; 61:83-90. [PMID: 31382005 DOI: 10.1016/j.avsg.2019.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 03/26/2019] [Accepted: 05/02/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine whether functional electrical stimulation (FES) is able to improve ischemic pain and quality of life of patients with diabetic arteriopathy (DA) in grade-IIa Leriche-Le Fontaine. MATERIAL AND METHODS This is a single-blinded, randomized, prospective cohort study. We included patients diagnosed with grade-IIa Leriche-Le Fontaine peripheral arterial disease in both lower extremities with and without diabetes mellitus (DM). The ankle-brachial index was 0.4-0.9. Patients were randomized into two experimental groups: nondiabetic (non-DM) (n = 71) and diabetic (DM) (n = 71). The patients received FES while walking for 1 hr on a supervised treadmill. Three months of follow-up were conducted after treatment. RESULTS A total of 168 patients were randomized; 142 completed the study, with 71 in each group. Both groups reported an improvement after the treatment, but the improvement was statistically significant in the DM group, in which all the parameters studied improved. Greater benefits were observed in all the parameters in the DM group after the follow-up, except for the test of the meters walked in 6 min. CONCLUSIONS The use of FES during daily walking is effective in patients with DA, reducing intermittent claudication and improving the quality of life of these patients.
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Kitamura H, Yamada S, Adachi T, Shibata K, Tamaki M, Okawa Y, Usui A. Effect of Perioperative Neuromuscular Electrical Stimulation in Patients Undergoing Cardiovascular Surgery: A Pilot Randomized Controlled Trial. Semin Thorac Cardiovasc Surg 2018; 31:361-367. [PMID: 30395965 DOI: 10.1053/j.semtcvs.2018.10.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 10/30/2018] [Indexed: 11/11/2022]
Abstract
A randomized, controlled trial was conducted to examine the effects of perioperative neuromuscular electrical stimulation on muscle proteolysis and physical function using blinded assessment of physical function. Consecutive patients undergoing cardiovascular surgery were screened for eligibility as study subjects. Participants were randomly assigned to receive either neuromuscular electrical stimulation or the usual postoperative mobilization program. The intervention group received neuromuscular electrical stimulation on bilateral legs 8 times before and after surgery. The primary outcomes were the mean 3-methylhistidine concentration corrected for urinary creatinine content from baseline to postoperative day 6, and knee extensor isometric muscle strength on postoperative day 7. Secondary outcomes were usual walking speed and grip strength. Physical therapists blinded to patient allocation performed measurements of physical function. Of 498 consecutive patients screened for eligibility, 119 participants (intervention group, n = 60; control group, n = 59) were enrolled. In the overall subjects, there were no differences in any outcomes between the intervention and control groups. The results demonstrated no significant effects of neuromuscular electrical stimulation on muscle proteolysis and physical function after cardiovascular surgery, suggesting the need to explore indications for neuromuscular electrical stimulation and to clarify the effects in terms of the dose-response relationship.
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Affiliation(s)
- Hideki Kitamura
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
| | - Sumio Yamada
- Department of Health Science, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Takuji Adachi
- Program in Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenichi Shibata
- Program in Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiac Rehabilitation, Nagoya Heart Center, Nagoya, Japan
| | - Mototsugu Tamaki
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Japan
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Fontes Cerqueira TC, de Cerqueira Neto ML, Cacau LDAP, Oliveira GU, da Silva Júnior WM, Carvalho VO, de Mendonça JT, de Santana Filho VJ. Ambulation capacity and functional outcome in patients undergoing neuromuscular electrical stimulation after cardiac valve surgery: A randomised clinical trial. Medicine (Baltimore) 2018; 97:e13012. [PMID: 30431575 PMCID: PMC6257613 DOI: 10.1097/md.0000000000013012] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Early mobilization and physical exercise are considered fundamental components in cardiovascular surgery rehabilitation; however, occasionally they are inadequate for inhibiting functional decline. Neuromuscular electrical stimulation (NMES) is a promising tool in cardiovascular rehabilitation; however, to date, no randomized clinical trial has measured the effects of NMES on functional capacity and quality of life in patients who undergo routine cardiac surgery with a short intensive care unit (ICU) stay. Therefore, we aimed to investigate the effects of NMES on walking ability, muscle strength, functional independence, and quality of life in cardiac valve surgery patients in the immediate postoperative period. METHODS A randomized, parallel, controlled, 2-arm clinical trial with assessor blinding was conducted. Fifty-nine adult patients in the preoperative period after cardiac valve reconstruction and/or replacement were randomly assigned to a control or intervention group. The intervention group underwent NMES in the quadriceps and gastrocnemius, bilaterally, for 60 minutes, for up to 10 sessions. The primary outcome was ambulation ability, assessed through the Six-Minute Walk Test and Walking Speed Test at postoperative day 5 (5PO). Secondary outcomes were muscular strength (assessed through the Medical Research Council scale), functional independence measure (assessed through the Functional Independence Measurement Questionnaire), and quality of life (assessed through the Nottingham Health Profile) at baseline (preoperative) and at postoperative days 3 and 5. RESULTS The baseline characteristics were similar in both groups, except for body mass index. There was no statistically significant difference, with a small effect size, between both groups regarding the distance walked (95% CI, -64.87 to 65.97) and walking speed (95% CI, -0.55 to 0.57). There was a statistically significant difference in upper-limb muscle strength loss and decline in mobility at postoperative day 3, which had a tendency to recover to initial values at 5PO, in both groups. No significant between-group difference was noted for muscle strength, functional independence, and quality of life. CONCLUSIONS The use of NMES had no effect on walking ability, strength, quality of life, or functional outcome in the postoperative period for patients that underwent regular valve replacement.
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Sachetti A, Carpes MF, Dias AS, Sbruzzi G. Safety of neuromuscular electrical stimulation among critically ill patients: systematic review. Rev Bras Ter Intensiva 2018; 30:219-225. [PMID: 29995088 PMCID: PMC6031422 DOI: 10.5935/0103-507x.20180036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 02/05/2018] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To review the evidence on the safety of neuromuscular electrical stimulation when used in the intensive care unit. METHODS A systematic review was conducted; a literature search was performed of the MEDLINE (via PubMed), PEDro, Cochrane CENTRAL and EMBASE databases, and a further manual search was performed among the references cited in randomized studies. Randomized clinical trials that compared neuromuscular electrical stimulation to a control or placebo group in the intensive care unit and reporting on the technique safety in the outcomes were included. Hemodynamic variables and information on adverse effects were considered safety parameters. Articles were independently analyzed by two reviewers, and the data analysis was descriptive. RESULTS The initial search located 1,533 articles, from which only four randomized clinical trials were included. Two studies assessed safety based on hemodynamic variables, and only one study reported an increase in heart rate, respiratory rate and blood lactate, without clinical relevance. The other two studies assessed safety based on reported adverse effects. In one, 15% of patients described a prickling sensation, without any clinically relevant abnormalities. In the other, one patient suffered a superficial burn due to improper parameter configuration. CONCLUSION Neuromuscular electrical stimulation is safe for critically ill patients; however, it should be applied by duly trained professionals and with proper evidence-based parameters.
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Affiliation(s)
- Amanda Sachetti
- Curso de Medicina, Escola de Saúde, IMED - Passo Fundo (RS),
Brasil
| | | | - Alexandre Simões Dias
- Hospital de Clínicas de Porto Alegre, Universidade Federal
do Rio Grande do Sul - Porto Alegre (RS), Brasil
| | - Graciele Sbruzzi
- Hospital de Clínicas de Porto Alegre, Universidade Federal
do Rio Grande do Sul - Porto Alegre (RS), Brasil
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Badger J, Taylor P, Swain I. The safety of electrical stimulation in patients with pacemakers and implantable cardioverter defibrillators: A systematic review. J Rehabil Assist Technol Eng 2017; 4:2055668317745498. [PMID: 31186945 PMCID: PMC6453072 DOI: 10.1177/2055668317745498] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/09/2017] [Indexed: 11/26/2022] Open
Abstract
Introduction A number of patients are excluded from electrical stimulation treatment
because there is concern that electrical stimulation could cause
electromagnetic interference with pacemakers and implanted cardioverter
defibrillators. The decision to use electrical stimulation in these patients
needs to be supported by an assessment of benefit and harm. Methods We conducted a systematic review of the risk of electromagnetic interference
between electrical stimulation and pacemakers or implanted cardioverter
defibrillators. We included the electronic databases MEDLINE and EMBASE in
the time period between 1966 and 26 August 2016. Results 18 papers fulfilled the inclusion criteria (eight safety studies and ten case
studies). Although we were unable to accurately estimate the risk of
electromagnetic interference, the studies revealed that patients having
electrical stimulation of the lower limb are less susceptible to
electromagnetic interference. Conclusions The results suggest that electrical stimulation could be used safely to help
drop foot in patients with pacemakers or implanted cardioverter
defibrillators. However, in order to obtain an accurate estimate of the risk
of electromagnetic interference, a large, long-term, and
intervention-specific safety study is required. Until such a study is
undertaken, electrical stimulation should be used with caution in patients
with pacemakers and implanted cardioverter defibrillators.
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Affiliation(s)
- James Badger
- 1Salisbury NHS Foundation Trust, Salisbury District Hospital, Salisbury, UK
| | | | - Ian Swain
- Odstock Medical Limited, Salisbury District Hospital, Salisbury, UK
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Embrey DG, Alon G, Brandsma BA, Vladimir F, Silva A, Pflugeisen BM, Amoroso PJ. Functional electrical stimulation improves quality of life by reducing intermittent claudication. Int J Cardiol 2017; 243:454-459. [PMID: 28595744 DOI: 10.1016/j.ijcard.2017.05.097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 05/10/2017] [Accepted: 05/29/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine if Functional Electrical Stimulation (FES) would improve ischemic pain, walking distance, and quality of life of patients with intermittent claudication. DESIGN Single blind, randomized block, two factorial design. PATIENTS Patients diagnosed with Peripheral Artery Disease (PAD) and intermittent claudication (IC). Ankle Brachial Index ranged 0.4-0.9 on at least one leg. Patients were randomly assigned to experimental (FES+Walk, N=13) or control (WALK, N=14) groups. INTERVENTION Experimental group patients received FES to the dorsiflexor and plantarflexor muscles while walking for 1h/day, six days/week for eight weeks. Control group patients received similar intervention without FES. A Follow-up period of both groups lasted eight weeks. OUTCOME MEASURES Outcome measures were taken at baseline (T0), after intervention (T1), and after follow-up (T2). Primary measures included Perceived Pain Intensity (PPI), Six minute walk (6MW), and Peripheral Arterial Disease Quality of Life (PADQOL). Secondary measures included Intermittent Claudication Questionnaire (ICQ) and Timed Up and Go (TUG). RESULTS Group by time interactions in PPI were significant (P<0.001) with differences of 27.9 points at T1 and 36.9 points at T2 favoring the FES+Walk group. Groups difference in Symptoms and Limitations in Physical Function of the PADQOL reached significance (T1=8.9, and T2=8.3 improvements; P=0.007). ICQ was significant (T1=9.3 and T2=13.1 improvements; P=0.003). Improvement in 6MW and TUG tests were similar between groups. CONCLUSIONS AND RELEVANCE Walking with FES markedly reduced ischemic pain and enhanced QOL compared to just walking. FES while walking may offer an effective treatment option for the elderly with PAD and Intermittent Claudication. TRIAL REGISTRATION NIH-NIA 1R21AG048001 https://projectreporter.nih.gov/project_info_description.cfm?aid=8748641&icde=30695377&ddparam=&ddvalue=&ddsub=&cr=1&csb=default&cs=ASC. https://clinicaltrials.gov/ct2/show/NCT02384980?term=David+Embrey&rank=1.
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Affiliation(s)
- David G Embrey
- MultiCare Institute for Research and Innovation, Tacoma, WA, USA
| | - Gad Alon
- University of Maryland, School of Medicine, Baltimore, MD, USA.
| | | | | | - Angela Silva
- MultiCare Institute for Research and Innovation, Tacoma, WA, USA
| | | | - Paul J Amoroso
- MultiCare Institute for Research and Innovation, Tacoma, WA, USA
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25
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Effects of Functional Electrical Stimulation Lower Extremity Training in Myotonic Dystrophy Type I: A Pilot Controlled Study. Am J Phys Med Rehabil 2017; 95:809-817. [PMID: 27088471 DOI: 10.1097/phm.0000000000000497] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Functional electrical stimulation (FES) is a new rehabilitative approach that combines electrical stimulation with a functional task. This pilot study evaluated the safety and effectiveness of FES lower extremity training in myotonic dystrophy type 1. DESIGN This is a controlled pilot study that enrolled 20 patients with myotonic dystrophy type 1 over 2 years. Eight patients (age, 39-67 years) fulfilled the inclusion criteria. Four participants performed FES cycling training for 15 days (one daily session of 30 minutes for 5 days a week). A control group, matched for clinical and genetic variables, who had contraindications to electrical stimulation, performed 6 weeks of conventional resistance and aerobic training. The modified Medical Research Council Scale and functional assessments were performed before and after treatment. Cohen d effect size was used for statistical analysis. RESULTS Functional electrical stimulation induced lower extremity training was well tolerated and resulted in a greater improvement of tibialis anterior muscle strength (d = 1,583), overall muscle strength (d = 1,723), and endurance (d = 0,626) than conventional training. CONCLUSIONS Functional electrical stimulation might be considered a safe and valid tool to improve muscle function, also in muscles severely compromised in which no other restorative options are available. Confirmation of FES efficacy through further clinical trials is strongly advised.
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Sewa Y, Tomita K, Okuno Y, Ose H, Imura S. Respiratory flow and vital signs associated with the intensity of functional electrical stimulation delivered to human abdominal muscles during quiet breathing. J Phys Ther Sci 2017; 28:3337-3341. [PMID: 28174447 PMCID: PMC5276756 DOI: 10.1589/jpts.28.3337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/09/2016] [Indexed: 02/02/2023] Open
Abstract
[Purpose] The purpose of this study was to examine the effects of increasing the
intensity of functional electrical stimulation delivered to abdominal muscles during quiet
breathing on respiratory flow, vital signs and pain in healthy subjects. [Subjects and
Methods] Electrical stimulation was delivered bilaterally using one pair of
high-conductivity gel-skin plate electrodes, placed on both sides of the abdomen, to nine
healthy males. Subjects were required to breathe normally through a face mask for 2
minutes while in a supine position. The stimulation intensity was incrementally increased
by 10 mA until reaching 100 mA. Respiratory parameters, vital signs and pain based on the
visual analog scale were measured for each intensity of electrical stimulation. [Results]
Transcutaneous oxygen saturation showed a slight upward trend in association with
increasing stimulation intensity, but there were no significant changes in pulse or blood
pressure. Respiratory flow, tidal volume, and minute ventilation increased significantly
as the stimulation intensity rose. [Conclusion] This study revealed that functional
electrical stimulation can be safely delivered to human abdominal muscles without causing
vital sign abnormalities. It was also found that the appropriate intensity level of
electrical stimulation for achieving effects on respiratory flow while also minimizing
pain is 60–80 mA.
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Affiliation(s)
- Yoko Sewa
- Graduate School of Health Science, Ibaraki Prefectural University of Health Sciences, Japan
| | - Kazuhide Tomita
- Graduate School of Health Science, Ibaraki Prefectural University of Health Sciences, Japan; Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Japan
| | - Yukako Okuno
- Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Japan
| | - Hirotaka Ose
- Graduate School of Health Science, Ibaraki Prefectural University of Health Sciences, Japan
| | - Shigeyuki Imura
- Graduate School of Health Science, Ibaraki Prefectural University of Health Sciences, Japan; Department of Physical Therapy, Ibaraki Prefectural University of Health Sciences, Japan
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A new weapon in the fight against postcardiac surgery muscle catabolism. J Thorac Cardiovasc Surg 2017; 153:379-380. [PMID: 28104196 DOI: 10.1016/j.jtcvs.2016.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 11/23/2022]
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Evidence based expert consensus for early rehabilitation in the intensive care unit. ACTA ACUST UNITED AC 2017. [DOI: 10.3918/jsicm.24_255] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Iwatsu K, Iida Y, Kono Y, Yamazaki T, Usui A, Yamada S. Neuromuscular electrical stimulation may attenuate muscle proteolysis after cardiovascular surgery: A preliminary study. J Thorac Cardiovasc Surg 2016; 153:373-379.e1. [PMID: 27793340 DOI: 10.1016/j.jtcvs.2016.09.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 08/02/2016] [Accepted: 09/09/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To explore the efficacy of postoperative neuromuscular electrical stimulation (NMES) on muscle protein degradation and muscle weakness in patients after cardiovascular surgery. METHODS Sixty-one patients underwent NMES daily from postoperative days (PODs) 1 to 5 in addition to postoperative mobilization program (NMES group), and 41 patients underwent postoperative mobilization program only (non-NMES group). The primary outcome was the concentration of 3-methylhistidine (3-MH) in 24-hour urine corrected for urinary creatinine content (3-MH/Cre) from PODs 1 to 5. The secondary outcomes were knee extensor isometric strength (KEIS) and handgrip strength at POD 7. RESULTS Baseline characteristics such as age, sex, preoperative body mass index, hemoglobin, handgrip strength, KEIS, surgery type, cardiopulmonary bypass time, and immediate postoperative interleukin-6 were not different between the groups. Urinary 3-MH/Cre was increased significantly in both groups; however, urinary 3-MH/Cre in the NMES group peaked earlier compared with that in the non-NMES group. KEIS at POD 7 was significantly greater in the NMES group (median [interquartile range], 0.40 kg/weight [0.33-0.45] in the NMES group vs 0.23 kg/weight [0.15-0.36] in the non-NMES group; P < .01). Handgrip strength at POD 7 was also significantly greater in the NMES group (median [interquartile range], 32 kg [24.5-35.3] in the NMES group vs 24 kg [16.0-30.0] in the non-NMES group; P < .01). CONCLUSIONS This study demonstrated that NMES might attenuate skeletal muscle protein degradation and muscle weakness after cardiovascular surgery. A cause-effect relationship between NMES and functional preservation would be a future challenging issue.
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Affiliation(s)
- Kotaro Iwatsu
- Program in Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuki Iida
- Program in Physical and Occupational Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Physiotherapy, Kainan Hospital, Yatomi, Japan
| | - Yuji Kono
- Department of Rehabilitation Science, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takenori Yamazaki
- Department of Cardiovascular Surgery, Kainan Hospital, Yatomi, Japan
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sumio Yamada
- Department of Rehabilitation Science, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Fischer A, Spiegl M, Altmann K, Winkler A, Salamon A, Themessl-Huber M, Mouhieddine M, Strasser EM, Schiferer A, Paternostro-Sluga T, Hiesmayr M. Muscle mass, strength and functional outcomes in critically ill patients after cardiothoracic surgery: does neuromuscular electrical stimulation help? The Catastim 2 randomized controlled trial. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:30. [PMID: 26825278 PMCID: PMC4733279 DOI: 10.1186/s13054-016-1199-3] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 01/18/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND The effects of neuromuscular electrical stimulation (NMES) in critically ill patients after cardiothoracic surgery are unknown. The objectives were to investigate whether NMES prevents loss of muscle layer thickness (MLT) and strength and to observe the time variation of MLT and strength from preoperative day to hospital discharge. METHODS In this randomized controlled trial, 54 critically ill patients were randomized into four strata based on the SAPS II score. Patients were blinded to the intervention. In the intervention group, quadriceps muscles were electrically stimulated bilaterally from the first postoperative day until ICU discharge for a maximum of 14 days. In the control group, the electrodes were applied, but no electricity was delivered. The primary outcomes were MLT measured by ultrasonography and muscle strength evaluated with the Medical Research Council (MRC) scale. The secondary functional outcomes were average mobility level, FIM score, Timed Up and Go Test and SF-12 health survey. Additional variables of interest were grip strength and the relation between fluid balance and MLT. Linear mixed models were used to assess the effect of NMES on MLT, MRC score and grip strength. RESULTS NMES had no significant effect on MLT. Patients in the NMES group regained muscle strength 4.5 times faster than patients in the control group. During the first three postoperative days, there was a positive correlation between change in MLT and cumulative fluid balance (r = 0.43, P = 0.01). At hospital discharge, all patients regained preoperative levels of muscle strength, but not of MLT. Patients did not regain their preoperative levels of average mobility (P = 0.04) and FIM score (P = 0.02) at hospital discharge, independent of group allocation. CONCLUSIONS NMES had no effect on MLT, but was associated with a higher rate in regaining muscle strength during the ICU stay. Regression of intramuscular edema during the ICU stay interfered with measurement of changes in MLT. At hospital discharge patients had regained preoperative levels of muscle strength, but still showed residual functional disability and decreased MLT compared to pre-ICU levels in both groups. TRIAL REGISTRATION Clinicaltrials.gov identifier NCT02391103. Registered on 7 March 2015.
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Affiliation(s)
- Arabella Fischer
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, General Intensive Care and Pain Control, Medical University of Vienna, Währingergürtel 18-20, 1090, Vienna, Austria.
| | - Matthias Spiegl
- Kantonsspital Sankt Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland.
| | - Klaus Altmann
- Krankenhaus der Barmherzigen Schwestern Ried, Schlossberg 1, 4910, Ried im Innkreis, Austria.
| | - Andreas Winkler
- University Hospital Landeskrankenhaus Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria.
| | - Anna Salamon
- Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Michael Themessl-Huber
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Mohamed Mouhieddine
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, General Intensive Care and Pain Control, Medical University of Vienna, Währingergürtel 18-20, 1090, Vienna, Austria.
| | - Eva Maria Strasser
- Institute for Physical Medicine and Rehabilitation, Kaiser-Franz-Josef-Spital Wien, Kundratstrasse 3, 1100, Vienna, Austria.
| | - Arno Schiferer
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, General Intensive Care and Pain Control, Medical University of Vienna, Währingergürtel 18-20, 1090, Vienna, Austria.
| | - Tatjana Paternostro-Sluga
- Institute for Physical Medicine and Rehabilitation, Donauspital Wien, Langobardenstraße 122, 1220, Vienna, Austria.
| | - Michael Hiesmayr
- Division of Cardiothoracic and Vascular Anesthesia and Intensive Care Medicine, Department of Anesthesia, General Intensive Care and Pain Control, Medical University of Vienna, Währingergürtel 18-20, 1090, Vienna, Austria.
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Aspects of physical medicine and rehabilitation in the treatment of deconditioned patients in the acute care setting: the role of skeletal muscle. Wien Med Wochenschr 2016; 166:28-38. [DOI: 10.1007/s10354-015-0418-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/09/2015] [Indexed: 02/07/2023]
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