Neuromuscular electrical stimulation for preventing skeletal-muscle weakness and wasting in critically ill patients: a systematic review
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BACKGROUND: Neuromuscular electrical stimulation (NMES) therapy may be useful in early musculoskeletal rehabilitation during acute critical illness. The objective of this systematic review was to evaluate the effectiveness of NMES for preventing skeletal-muscle weakness and wasting in critically ill patients, in comparison with usual care. METHODS: We searched PubMed, CENTRAL, CINAHL, Web of Science, and PEDro to identify randomized controlled trials exploring the effect of NMES in critically ill patients, which had a well-defined NMES protocol, provided outcomes related to skeletal-muscle strength and/or mass, and for which full text was available. Two independent reviewers extracted data on muscle-related outcomes (strength and mass), and participant and intervention characteristics, and assessed the methodological quality of the studies. Owing to the lack of means and standard deviations (SDs) in some studies, as well as the lack of baseline measurements in two studies, it was impossible to conduct a full meta-analysis. When means and SDs were provided, the effect sizes of individual outcomes were calculated, and otherwise, a qualitative analysis was performed. RESULTS: The search yielded 8 eligible studies involving 172 patients. The methodological quality of the studies was moderate to high. Five studies reported an increase in strength or better preservation of strength with NMES, with one study having a large effect size. Two studies found better preservation of muscle mass with NMES, with small to moderate effect sizes, while no significant benefits were found in two other studies. CONCLUSIONS: NMES added to usual care proved to be more effective than usual care alone for preventing skeletal-muscle weakness in critically ill patients. However, there is inconclusive evidence for its benefit in prevention of muscle wasting.
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Pulse frequencies used in skin surface stimulation are generally in the range of 8 to 100 Hz, and therefore below frequency ranges commonly observed in neural stimulation.
“Pulse frequencies used in skin surface stimulation are generally in the range of 8 to 100 Hz [102], and therefore below frequency ranges commonly observed in neural stimulation (see Table 4).”
From Safety of long-term electrical peripheral nerve stimulation: review of the state of the art (2019) · cites this paper as [102]
The Results > Interventions section reports stimulation frequencies of 8–100 Hz in the NMES studies reviewed. Those studies involved critically ill patients, so the source does not establish that this is generally the range for skin-surface stimulation. The comparison with neural stimulation follows the citation and is not attributed to this source. (LLM, conf=0.82)
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- Authors
- Maffiuletti, N. A., Roig, M., Karatzanos, E., & Nanas, S.
- Affiliations
- Schulthess-Klinik (CH)
- University of Copenhagen (DK)
- National and Kapodistrian University of Athens (GR)
- Corresponding author
- Maffiuletti, Nicola A
- Venue
- BMC Medicine
- Published
- 2013-05-23
- Volume
- 11
- Issue
- 1
- Pages
- 137-137
- ISSN
- 1741-7015 (ISSN-L)
- PMC
- PMC3668245
- OpenAlex
- W2136166854
- Cited by
- 199
- References
- 74
- Citations by year
- 2026: 9 · 2025: 10 · 2024: 7 · 2023: 14 · 2022: 15 · 2021: 19 · 2020: 17 · 2019: 23 · 2018: 17 · 2017: 16 · 2016: 14 · 2015: 15 · 2014: 17 · 2013: 5
- FWCI
- 1.94
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
- Funders
- Elsass Fonden
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Keywords
- neuromuscular electrical stimulation, critical illness, skeletal muscle weakness, muscle atrophy, muscle strength, muscle mass, critically ill patients
- MeSH terms
- Electric Stimulation Therapy, Humans, Neuromuscular Junction, Randomized Controlled Trials as Topic, Critical Illness, Muscle Weakness, Muscle Strength
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