Feasibility Within-subject RCT of Neuromuscular Electrical Stimulation; an Intervention to Maintain and Improve NeuroMuscular Function During Period of Immobility (IMMI)

Overview

Journal Eur Geriatr Med

Specialty Geriatrics

Date 2025 Jan 8

PMID 39775747

Authors

Helal B Alqurashi

Tahir Masud

Adam Lee Gordon

Mathew Piasecki

Dominic OConnor

Katie Robinson

John R F Gladman

Affiliations

Soon will be listed here.

Abstract

Introduction: Neuromuscular electrical stimulation (NMES) is a potentially effective intervention to improve outcomes after a fragility fracture, but its feasibility in this group has not been established.

Methods: A feasibility study was conducted in two phases: 1) in the hospital only, and 2) hospital, rehabilitation centres, and participants' homes. Patients with fragility fracture were randomised to receive NMES for 6 weeks/discharge either to the right or left leg, with the other leg serving as control. Patients who had no mobility issues had contraindications to NMES and were unable to give consent were excluded. NMES was applied to quadriceps and tibialis anterior muscles for 30 min, 3 days/week. Sessions were progressed to achieve 60 min, 5-7 days/week. Feasibility outcomes included participant characteristics, recruitment rate, tolerability, and number of NMES sessions. Clinical outcomes included muscle strength, and ADL at six months.

Results: Overall, 1052 patients were identified, of whom 113 (11%) were eligible, and 29 (3%) were recruited (median Clinical Frailty Score 3, median Barthel ADL score 93/100). The recruitment rate was 0.45/week in phase 1 and 0.9/week in phase 2. Fifty-three percent achieved the target of 24 NMES sessions. However, 5/29 withdrew due to intolerance of NMES. Leg muscle strength improved in both treated and untreated legs, with marginally greater improvement observed in the tibialis anterior of treated legs.

Conclusion: Although it would be feasible to evaluate the specific effect of NMES in fragility fracture patients in a multi-centre trial using home-based NMES, this would be possible only in a minority of mildly frail fragility fracture patients with little premorbid disability.

References

Loyd C, Markland A, Zhang Y, Fowler M, Harper S, Wright N . Prevalence of Hospital-Associated Disability in Older Adults: A Meta-analysis. J Am Med Dir Assoc. 2019; 21(4):455-461.e5. PMC: 7469431. DOI: 10.1016/j.jamda.2019.09.015. View

Covinsky K, Pierluissi E, Johnston C . Hospitalization-associated disability: "She was probably able to ambulate, but I'm not sure". JAMA. 2011; 306(16):1782-93. DOI: 10.1001/jama.2011.1556. View

Martinez-Velilla N, Casas-Herrero A, Zambom-Ferraresi F, Saez de Asteasu M, Lucia A, Galbete A . Effect of Exercise Intervention on Functional Decline in Very Elderly Patients During Acute Hospitalization: A Randomized Clinical Trial. JAMA Intern Med. 2018; 179(1):28-36. PMC: 6583412. DOI: 10.1001/jamainternmed.2018.4869. View

Miranda Rocha A, Martinez B, Maldaner da Silva V, Forgiarini Junior L . Early mobilization: Why, what for and how?. Med Intensiva. 2017; 41(7):429-436. DOI: 10.1016/j.medin.2016.10.003. View

Jose A, Dal Corso S . Inpatient rehabilitation improves functional capacity, peripheral muscle strength and quality of life in patients with community-acquired pneumonia: a randomised trial. J Physiother. 2016; 62(2):96-102. DOI: 10.1016/j.jphys.2016.02.014. View

Borges R, Carvalho C . Impact of resistance training in chronic obstructive pulmonary disease patients during periods of acute exacerbation. Arch Phys Med Rehabil. 2014; 95(9):1638-45. DOI: 10.1016/j.apmr.2014.05.007. View

Camp P, Reid W, Chung F, Kirkham A, Brooks D, Goodridge D . Clinical Decision-Making Tool for Safe and Effective Prescription of Exercise in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: Results From an Interdisciplinary Delphi Survey and Focus Groups. Phys Ther. 2015; 95(10):1387-96. PMC: 4595812. DOI: 10.2522/ptj.20140542. View

Rice H, Harrold M, Fowler R, Watson C, Waterer G, Hill K . Exercise training for adults hospitalized with an acute respiratory condition: a systematic scoping review. Clin Rehabil. 2019; 34(1):45-55. DOI: 10.1177/0269215519877930. View

Nussbaum E, Houghton P, Anthony J, Rennie S, Shay B, Hoens A . Neuromuscular Electrical Stimulation for Treatment of Muscle Impairment: Critical Review and Recommendations for Clinical Practice. Physiother Can. 2017; 69(5):1-76. PMC: 5683854. DOI: 10.3138/ptc.2015-88. View

10.

Alqurashi H, Robinson K, OConnor D, Piasecki M, Gordon A, Masud T . The effects of neuromuscular electrical stimulation on hospitalised adults: systematic review and meta-analysis of randomised controlled trials. Age Ageing. 2023; 52(12). PMC: 10756181. DOI: 10.1093/ageing/afad236. View

11.

Langeard A, Bigot L, Chastan N, Gauthier A . Does neuromuscular electrical stimulation training of the lower limb have functional effects on the elderly?: A systematic review. Exp Gerontol. 2017; 91:88-98. DOI: 10.1016/j.exger.2017.02.070. View

12.

Pergolotti M, Deal A, Williams G, Bryant A, McCarthy L, Nyrop K . Older Adults with Cancer: A Randomized Controlled Trial of Occupational and Physical Therapy. J Am Geriatr Soc. 2019; 67(5):953-960. PMC: 6494097. DOI: 10.1111/jgs.15930. View

13.

Young J, Green J, Forster A, Small N, Lowson K, Bogle S . Postacute care for older people in community hospitals: a multicenter randomized, controlled trial. J Am Geriatr Soc. 2007; 55(12):1995-2002. DOI: 10.1111/j.1532-5415.2007.01456.x. View

14.

Thalmann M, Troster T, Fischer K, Bieri-Bruning G, Beeler P, Bischoff-Ferrari H . Do older adults benefit from post-acute care following hospitalisation? A prospective cohort study at three Swiss nursing homes. Swiss Med Wkly. 2020; 150:w20198. DOI: 10.4414/smw.2020.20198. View

15.

Jones S, Carley S, Harrison M . An introduction to power and sample size estimation. Emerg Med J. 2003; 20(5):453-8. PMC: 1726174. DOI: 10.1136/emj.20.5.453. View

16.

Minetto M, Botter A, Gamerro G, Varvello I, Massazza G, Bellomo R . Contralateral effect of short-duration unilateral neuromuscular electrical stimulation and focal vibration in healthy subjects. Eur J Phys Rehabil Med. 2018; 54(6):911-920. DOI: 10.23736/S1973-9087.18.05004-9. View

17.

Rittweger J . Vibration as an exercise modality: how it may work, and what its potential might be. Eur J Appl Physiol. 2009; 108(5):877-904. DOI: 10.1007/s00421-009-1303-3. View

18.

Spruit M, Wouters E . New modalities of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease. Sports Med. 2007; 37(6):501-18. DOI: 10.2165/00007256-200737060-00004. View

19.

Ikeda T, Katayama S, Kitagawa T . The combined intervention of neuromuscular electrical stimulation and nutrition therapy: A scoping review. Clin Nutr ESPEN. 2023; 54:239-250. DOI: 10.1016/j.clnesp.2023.01.027. View

20.

Pano-Rodriguez A, Beltran-Garrido J, Hernandez-Gonzalez V, Reverter-Masia J . Effects of whole-body ELECTROMYOSTIMULATION on health and performance: a systematic review. BMC Complement Altern Med. 2019; 19(1):87. PMC: 6480820. DOI: 10.1186/s12906-019-2485-9. View