1
|
Alqurashi HB, Robinson K, O’Connor D, Piasecki M, Gordon AL, Masud T, Gladman JRF. The effects of neuromuscular electrical stimulation on hospitalised adults: systematic review and meta-analysis of randomised controlled trials. Age Ageing 2023; 52:afad236. [PMID: 38156975 PMCID: PMC10756181 DOI: 10.1093/ageing/afad236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION Neuromuscular electrical stimulation (NMES) is a treatment to prevent or reverse acquired disability in hospitalised adults. We conducted a systematic review and meta-analysis of its effectiveness. METHOD We searched MEDLINE, EMBASE, Cumulative Index to Nursing & Allied Health (CINAHL) and the Cochrane library. Inclusion criteria: randomised controlled trials of hospitalised adult patients comparing NMES to control or usual care. The primary outcome was muscle strength. Secondary outcomes were muscle size, function, hospital length of stay, molecular and cellular biomarkers, and adverse effects. We assessed risk of bias using the Cochrane risk-of-bias tool. We used Review Manager (RevMan) software for data extraction, critical appraisal and synthesis. We assessed certainty using the Grading of Recommendations Assessment, Development and Evaluation tool. RESULTS A total of 42 papers were included involving 1,452 participants. Most studies had unclear or high risk of bias. NMES had a small effect on muscle strength (moderate certainty) (standardised mean difference (SMD) = 0.33; P < 0.00001), a moderate effect on muscle size (moderate certainty) (SMD = 0.66; P < 0.005), a small effect on walking performance (moderate certainty) (SMD = 0.48; P < 0.0001) and a small effect on functional mobility (low certainty) (SMD = 0.31; P < 0.05). There was a small and non-significant effect on health-related quality of life (very low certainty) (SMD = 0.35; P > 0.05). In total, 9% of participants reported undesirable experiences. The effects of NMES on length of hospital stay, and molecular and cellular biomarkers were unclear. CONCLUSIONS NMES is a promising intervention component that might help to reduce or prevent hospital-acquired disability.
Collapse
Affiliation(s)
- Helal B Alqurashi
- University of Nottingham, Nottingham, UK
- Department of Physical Therapy, Faculty of Applied Medical Science, Taif University, Taif, Saudi Arabia
- NIHR Nottingham Biomedical Research Centre (BRC), UK
| | - Katie Robinson
- University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Mathew Piasecki
- University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), UK
| | - Adam L Gordon
- University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), UK
- NIHR Applied Research Collaboration (ARC) East Midlands, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Tahir Masud
- NIHR Nottingham Biomedical Research Centre (BRC), UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - John R F Gladman
- University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre (BRC), UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
- NIHR Applied Research Collaboration (ARC) East Midlands, UK
| |
Collapse
|
2
|
Takahashi Y, Morisawa T, Okamoto H, Matsumoto N, Saitoh M, Takahashi T, Fujiwara T. Relationship Between Skeletal Muscle Quality and Hospital-Acquired Disability in Patients With Sepsis Admitted to the ICU: A Pilot Study. Crit Care Explor 2023; 5:e0835. [PMID: 36699248 DOI: 10.1097/CCE.0000000000000835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Early risk assessment of functional decline in patients with sepsis is clinically challenging. Recently, there is increasing interest in the nonvolitional evaluation of skeletal muscle quality. OBJECTIVES The aim of this study was to assess the relationship between skeletal muscle quality and functional decline after intensive care. DESIGN SETTING AND PARTICIPANTS This pilot study was a single-center prospective observational study conducted from March 2021 to February 2022. We included consecutive patients with sepsis who were admitted to our ICU. MAIN OUTCOMES AND MEASURES The primary outcome was hospital-acquired disability (HAD), which is defined as a decrease in the Barthel index score of at least 5 points from pre-hospital to hospital discharge. Muscle quality was assessed by: 1) muscle echogenicity with ultrasound and 2) phase angle (PhA) with bioelectrical impedance analysis, both of which were measured on ICU days less than 3, 3-5, 5-7, 7-10, and 10-14. We compared longitudinal changes in muscle echogenicity and PhA between the HAD and non-HAD groups using two-way repeated measures analysis of variance with mixed models. RESULTS Among the 22 patients, 7 (31.8%) had HAD. Muscle echogenicity was higher in the HAD group than in the non-HAD group (p < 0.001); however, no interaction effects were found between the two groups (p = 0.189). PhA showed a main effect on each evaluation day in patients (p = 0.040) and a significant interaction effect between the groups, including an early decreased pattern in the HAD group (p = 0.036). CONCLUSIONS AND RELEVANCE Higher muscle echogenicity and a decreased PhA pattern are related to HAD. Noninvasive assessment of muscle quality using ultrasound and bioelectrical impedance analysis may be useful in predicting the functional prognosis of patients with sepsis.
Collapse
|
3
|
Nemoto S, Kasahara Y, Izawa KP, Watanabe S, Yoshizawa K, Takeichi N, Akao K, Watanabe S, Mizukoshi K, Suzuki N, Ashikaga K, Kida K, Osada N, Akashi YJ. Hospital-acquired disability in older heart failure patients decreases independence and increases difficulties in activities of daily living. Eur J Cardiovasc Nurs 2022; 22:355-363. [PMID: 36219174 DOI: 10.1093/eurjcn/zvac096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 11/14/2022]
Abstract
AIMS The aim of this study was to clarify whether worsening of independence in activities of daily living (ADL) and also difficulties in ADL are triggered by hospitalization in older patients with heart failure (HF) and whether difficulties in ADL can predict readmission for HF regardless of independence in ADL in these patients. METHODS AND RESULTS We enrolled 241 HF patients in the present multi-institutional, prospective, observational study. The patients were divided according to age into the non-older patient group (<75 years, n = 137) and the older patient group (≥75 years, n = 104). The Katz index and the Performance Measure for Activities of Daily Living-8 (PMADL-8) were used to evaluate independence and difficulties in ADL, respectively. The endpoint of this study was rehospitalization for HF. Independence as indicated by the Katz index at discharge was significantly lower than that before admission only in the older patient group, and the value of the PMADL-8 at discharge was significantly higher than that before admission (P < 0.001). In all patients, after adjusting for the Katz index and other variables, PMADL-8 score was a significant predictor of rehospitalization for HF (hazard ratio 1.50; 95% confidence interval 1.07 to 2.13; P = 0.021). CONCLUSIONS Worsening of both independence and difficulties in ADL was triggered by hospitalization in older HF patients, and difficulties in ADL were relevant factors for risk of rehospitalization regardless of independence in ADL. These findings indicate the importance of preventing not only decreased independence but also increased difficulties in ADL during and after hospitalization.
Collapse
Affiliation(s)
- Shinji Nemoto
- Department of Physical Therapy, Showa University School of Nursing and Rehabilitation Sciences, Yokohama, Japan
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yusuke Kasahara
- Department of Rehabilitation Medicine, St. Marianna University School of Medicine Hospital, Kawasaki, Japan
| | - Kazuhiro P Izawa
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
- Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Satoshi Watanabe
- Department of Rehabilitation Medicine, St. Marianna University School of Medicine Hospital, Kawasaki, Japan
| | - Kazuya Yoshizawa
- Department of Rehabilitation Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan
| | - Naoya Takeichi
- Department of Rehabilitation Medicine, St. Marianna University School of Medicine Hospital, Kawasaki, Japan
| | - Keigo Akao
- Department of Rehabilitation Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan
| | - Sato Watanabe
- Department of Rehabilitation Medicine, St. Marianna University School of Medicine Toyoko Hospital, Kawasaki, Japan
| | - Kei Mizukoshi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan
| | - Norio Suzuki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine Hospital, Kawasaki, Japan
| | - Kohei Ashikaga
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
- Department of Sport Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Keisuke Kida
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
- Department of Pharmacology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Naohiko Osada
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine Toyoko Hospital, Kawasaki, Japan
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine Hospital, Kawasaki, Japan
| |
Collapse
|