Functional electrical stimulation improves activity after stroke: a systematic review with meta-analysis

Owen A Howlett; Natasha A Lannin; Louise Ada; Carol McKinstry

doi:10.1016/j.apmr.2015.01.013

Functional electrical stimulation improves activity after stroke: a systematic review with meta-analysis

Arch Phys Med Rehabil. 2015 May;96(5):934-43. doi: 10.1016/j.apmr.2015.01.013. Epub 2015 Jan 26.

Authors

Owen A Howlett¹, Natasha A Lannin², Louise Ada³, Carol McKinstry⁴

Affiliations

¹ Department of Occupational Therapy, La Trobe University, Bundoora, VIC, Australia; Bendigo Health, Bendigo, VIC, Australia. Electronic address: ohowlett@bendigohealth.org.au.
² Department of Occupational Therapy, La Trobe University, Bundoora, VIC, Australia; Occupational Therapy Department, Alfred Health, Prahran, VIC, Australia; The John Walsh Centre of Rehabilitation Research, Sydney Medical School (Northern), University of Sydney, St Leonards, NSW, Australia.
³ Department of Physiotherapy, University of Sydney, Lidcombe, NSW; and La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia.
⁴ Department of Occupational Therapy, La Trobe University, Bundoora, VIC, Australia.

PMID: 25634620
DOI: 10.1016/j.apmr.2015.01.013

Abstract

Objective: To investigate the effect of functional electrical stimulation (FES) in improving activity and to investigate whether FES is more effective than training alone.

Data sources: Cochrane Central Register of Controlled Trials, Ovid Medline, EBSCO Cumulative Index to Nursing and Allied Health Literature, Ovid EMBASE, Physiotherapy Evidence Database (PEDro), and Occupational Therapy Systematic Evaluation of Effectiveness.

Study selection: Randomized and controlled trials up to June 22, 2014, were included following predetermined search and selection criteria.

Data extraction: Data extraction occurred by 2 people independently using a predetermined data collection form. Methodologic quality was assessed by 2 reviewers using the PEDro methodologic rating scale. Meta-analysis was conducted separately for the 2 research objectives.

Data synthesis: Eighteen trials (19 comparisons) were eligible for inclusion in the review. FES had a moderate effect on activity (standardized mean difference [SMD], .40; 95% confidence interval [CI], .09-.72) compared with no or placebo intervention. FES had a moderate effect on activity (SMD, .56; 95% CI, .29-.92) compared with training alone. When subgroup analyses were performed, FES had a large effect on upper-limb activity (SMD, 0.69; 95% CI, 0.33-1.05) and a small effect on walking speed (mean difference, .08m/s; 95% CI, .02-.15) compared with control groups.

Conclusions: FES appears to moderately improve activity compared with both no intervention and training alone. These findings suggest that FES should be used in stroke rehabilitation to improve the ability to perform activities.

Keywords: Meta-analysis [publication type]; Occupational therapy; Rehabilitation; Review [publication type].

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Clinical Trials as Topic
Electric Stimulation Therapy / methods*
Exercise Therapy / methods*
Humans
Occupational Therapy / methods*
Stroke Rehabilitation*