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Lin SD, Butler JE, Boswell-Ruys CL, Hoang PD, Jarvis T, Gandevia SC, McCaughey EJ. The effect of abdominal functional electrical stimulation on bowel function in multiple sclerosis: a cohort study. Mult Scler J Exp Transl Clin 2020; 6:2055217320941530. [PMID: 34691757 PMCID: PMC8529907 DOI: 10.1177/2055217320941530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 05/12/2020] [Accepted: 06/09/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Chronic constipation is prevalent in people with multiple sclerosis, with current treatments usually only partially effective. OBJECTIVES This study aims to evaluate the efficacy of abdominal functional electrical stimulation to reduce whole gut and colonic transit times and improve bowel and bladder-related quality of life. METHODS A total of 23 people with multiple sclerosis who fulfilled the Rome III criteria for functional constipation applied abdominal functional electrical stimulation for 1 hour per day, 5 days per week, for 6 weeks. Whole gut and colonic transit times and bowel and bladder-related quality of life were measured before and after the intervention period. RESULTS Whole gut (mean 81.3 (standard deviation 28.7) hours pre vs. 96.1 (standard deviation 53.6) hours post-intervention, P = 0.160) and colonic transit time (65.1 (31.4) vs. 74.8 (51.1) hours, P = 0.304) were unchanged following 6 weeks of abdominal functional electrical stimulation. There was a significant improvement in bowel (mean 1.78 (SD: 0.64) pre vs. 1.28 (SD: 0.54) post, P = 0.001) and bladder (50.6 (26.49) vs. 64.5 (21.92), p = 0.007) related quality of life after the intervention period. CONCLUSION While abdominal functional electrical stimulation did not reduce whole gut and colonic transit times for people with multiple sclerosis, a significant improvement in bowel and bladder-related quality of life was reported.
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Affiliation(s)
| | | | - Claire L Boswell-Ruys
- Neuroscience Research Australia, Australia
- School of Medical Sciences, University of New South Wales, Australia
| | - Phu D Hoang
- Neuroscience Research Australia, Australia
- School of Medical Sciences, University of New South Wales, Australia
- Continence Clinic, MS Limited, Australia
- Faculty of Health Sciences, Australian Catholic University, Australia
| | - Tom Jarvis
- Continence Clinic, MS Limited, Australia
- Prince of Wales Clinical School, University of New South Wales, Australia
| | - Simon C Gandevia
- Neuroscience Research Australia, Australia
- School of Medical Sciences, University of New South Wales, Australia
- Prince of Wales Clinical School, University of New South Wales, Australia
| | - Euan J McCaughey
- Neuroscience Research Australia, Australia
- School of Medical Sciences, University of New South Wales, Australia
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McCaughey EJ, Jonkman AH, Boswell-Ruys CL, McBain RA, Bye EA, Hudson AL, Collins DW, Heunks LMA, McLachlan AJ, Gandevia SC, Butler JE. Abdominal functional electrical stimulation to assist ventilator weaning in critical illness: a double-blinded, randomised, sham-controlled pilot study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:261. [PMID: 31340846 PMCID: PMC6657036 DOI: 10.1186/s13054-019-2544-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 07/16/2019] [Indexed: 01/15/2023]
Abstract
Background For every day a person is dependent on mechanical ventilation, respiratory and cardiac complications increase, quality of life decreases and costs increase by > $USD 1500. Interventions that improve respiratory muscle function during mechanical ventilation can reduce ventilation duration. The aim of this pilot study was to assess the feasibility of employing an abdominal functional electrical stimulation (abdominal FES) training program with critically ill mechanically ventilated patients. We also investigated the effect of abdominal FES on respiratory muscle atrophy, mechanical ventilation duration and intensive care unit (ICU) length of stay. Methods Twenty critically ill mechanically ventilated participants were recruited over a 6-month period from one metropolitan teaching hospital. They were randomly assigned to receive active or sham (control) abdominal FES for 30 min, twice per day, 5 days per week, until ICU discharge. Feasibility was assessed through participant compliance to stimulation sessions. Abdominal and diaphragm muscle thickness were measured using ultrasound 3 times in the first week, and weekly thereafter by a blinded assessor. Respiratory function was recorded when the participant could first breathe independently and at ICU discharge, with ventilation duration and ICU length of stay also recorded at ICU discharge by a blinded assessor. Results Fourteen of 20 participants survived to ICU discharge (8, intervention; 6, control). One control was transferred before extubation, while one withdrew consent and one was withdrawn for staff safety after extubation. Median compliance to stimulation sessions was 92.1% (IQR 5.77%) in the intervention group, and 97.2% (IQR 7.40%) in the control group (p = 0.384). While this pilot study is not adequately powered to make an accurate statistical conclusion, there appeared to be no between-group thickness changes of the rectus abdominis (p = 0.099 at day 3), diaphragm (p = 0.652 at day 3) or combined lateral abdominal muscles (p = 0.074 at day 3). However, ICU length of stay (p = 0.011) and ventilation duration (p = 0.039) appeared to be shorter in the intervention compared to the control group. Conclusions Our compliance rates demonstrate the feasibility of using abdominal FES with critically ill mechanically ventilated patients. While abdominal FES did not lead to differences in abdominal muscle or diaphragm thickness, it may be an effective method to reduce ventilation duration and ICU length of stay in this patient group. A fully powered study into this effect is warranted. Trial registration The Australian New Zealand Clinical Trials Registry, ACTRN12617001180303. Registered 9 August 2017.
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Affiliation(s)
- Euan J McCaughey
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia. .,School of Medical Sciences, University of New South Wales, Kensington, NSW, 2052, Australia.
| | - Annemijn H Jonkman
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, The Netherlands
| | - Claire L Boswell-Ruys
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia.,School of Medical Sciences, University of New South Wales, Kensington, NSW, 2052, Australia.,Prince of Wales Hospital, Randwick, NSW, 2031, Australia
| | - Rachel A McBain
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia.,School of Medical Sciences, University of New South Wales, Kensington, NSW, 2052, Australia.,Prince of Wales Hospital, Randwick, NSW, 2031, Australia
| | - Elizabeth A Bye
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia.,School of Medical Sciences, University of New South Wales, Kensington, NSW, 2052, Australia.,Prince of Wales Hospital, Randwick, NSW, 2031, Australia
| | - Anna L Hudson
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia.,School of Medical Sciences, University of New South Wales, Kensington, NSW, 2052, Australia
| | | | - Leo M A Heunks
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan, 1117, Amsterdam, The Netherlands
| | - Angus J McLachlan
- Liberate Medical LLC, 6400 Westwind Way, Suite A, Crestwood, KY, 40014, USA
| | - Simon C Gandevia
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia.,School of Medical Sciences, University of New South Wales, Kensington, NSW, 2052, Australia.,Prince of Wales Hospital, Randwick, NSW, 2031, Australia
| | - Jane E Butler
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia.,School of Medical Sciences, University of New South Wales, Kensington, NSW, 2052, Australia
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