To examine the effectiveness of neuromuscular electrical stimulation (NMES) for the management of shoulder subluxation after stroke including assessment of short (1 hour or less) and long (more than one hour) daily treatment duration.
Data sources:
MEDLINE, CENTRAL, CINAHL, WOS, KoreaMed, RISS and reference lists from inception to January 2017
Review methods:
We considered randomized controlled trials that reported neuromuscular electrical stimulation for the treatment of shoulder subluxation post-stroke. Two reviewers independently selected trials for inclusion, assessed trial quality, and extracted data.
Results:
Eleven studies were included (432 participants); seven studies were good quality, four were fair. There was a significant treatment effect of neuromuscular electrical stimulation for reduction of subluxation for persons with acute and subacute stroke (SMD:–1.11; 95% CI:–1.53, –0.68) with either short (SMD:–0.91; 95% CI:–1.43, –0.40) or long (SMD:–1.49; 95% CI:–2.31, –0.67) daily treatment duration. The effect for patients with chronic stroke was not significant (SMD:–1.25; 95% CI:–2.60, 0.11). There was no significant effect of neuromuscular electrical stimulation on arm function or shoulder pain.
Conclusion:
This meta-analysis suggests a beneficial effect of neuromuscular electrical stimulation, with either short or long daily treatment duration, for reducing shoulder subluxation in persons with acute and subacute stroke. No significant benefits were observed for persons with chronic stroke or for improving arm function or reducing shoulder pain.
PaciMNannettiLRinaldiLA.Glenohumeral subluxation in hemiplegia: An overview. J Rehabil Res Dev2005;42:557–568.
2.
GriffinC.Management of the hemiplegic shoulder complex. Top Stroke Rehabil2014;21:316–318.
3.
StolzenbergDSiuGCruzE.Current and future interventions for glenohumeral subluxation in hemiplegia secondary to stroke. Top Stroke Rehabil2012;19:444–456.
4.
KumarPSwinkelsA.A critical review of shoulder subluxation and its association with other post-stroke complications. Phys Ther Rev2009;14:13–25.
5.
KumarPKassamJDentonCTaylorEChatterleyA.Risk factors for inferior shoulder subluxation in patients with stroke. Phys Ther Rev2010;15:3–11.
6.
BakerLLParkerK.Neuromuscular electrical stimulation of the muscles surrounding the shoulder. Phys Ther1986;66:1930–1937.
7.
PriceCIPandyanAD.Electrical stimulation for preventing and treating post-stroke shoulder pain: a systematic Cochrane review. Clin Rehabil2001;15:5–19.
8.
AdaLFoongchomcheayA.Efficacy of electrical stimulation in preventing or reducing subluxation of the shoulder after stroke: a meta-analysis. Aust J Physiother2002;48:257–267.
9.
Van PeppenRPKwakkelGWood-DauphineeSHendriksHJVan der WeesPJDekkerJ.The impact of physical therapy on functional outcomes after stroke: what’s the evidence?Clin Rehabil2004;18:833–862.
10.
VafadarAKCôtéJNArchambaultPS.Effectiveness of functional electrical stimulation in improving clinical outcomes in the upper arm following stroke: a systematic review and meta-analysis. Biomed Res Int2015;2015:729768.
11.
GuPRanJJ.Electrical stimulation for hemiplegic shoulder function: a systematic review and meta-analysis of 15 randomized controlled trials. Arch Phys Med Rehabil2016;97:1588–1594.
12.
FaghriPDRodgersMMGlaserRMBorsJGHoCAkuthotaP.The effects of functional electrical stimulation on shoulder subluxation, arm function recovery, and shoulder pain in hemiplegic stroke patients. Arch Phys Med Rehabil1994;75:73–79.
13.
LinnSLGranatMHLeesKR.Prevention of shoulder subluxation after stroke with electrical stimulation. Stroke1999;30:963–968.
14.
WangRYChanRCTsaiMW.Functional electrical stimulation on chronic and acute hemiplegic shoulder subluxation. Am J Phys Med Rehabil2000;79:385–390
15.
WangRYYangYRTsaiMWWangWTChanRC.Effects of functional electric stimulation on upper limb motor function and shoulder range of motion in hemiplegic patients. Am J Phys Med Rehabil2002;81:283–290.
16.
KimKKKangMJShinOSImMSLeeKHParkSWet al. The effect of functional electrical stimulation on hemiplegic shoulder subluxation. J Korean Acad Rehabil Med2000;24:402–409.
17.
KoyuncuENakipoğlu-YüzerGFDoğanAOzgirginN.The effectiveness of functional electrical stimulation for the treatment of shoulder subluxation and shoulder pain in hemiplegic patients: A randomized controlled trial. Disabil Rehabil2010;32:560–566.
18.
KimDYParkCINahSI.Effects of functional electrical stimulation on shoulder subluxation of poststroke hemiplegic patients. Korean J Stroke2001;3:158–163.
19.
KangMK.The effect of EMG-triggered electrical stimulation on shoulder subluxation in acute stroke patients. Mater Thesis, Wokwang University, Korea, 2004.
20.
ChaIK.Effects of functional electrical stimulation for shoulder subluxation in patients with chronic hemiplegia. Master Thesis, Dankook University, Korea, 2007.
21.
Shim–. Effect of subluxation functional electrical stimulation on pain, subluxation space, upper extremity function, quality of life of stroke patients. Master Thesis, Hallym University, Korea, 2011.
22.
LiuJYouWXSunD.Effects of functional electric stimulation on shoulder subluxation and upper limb motor function recovery of patients with hemiplegia resulting from stroke. Di Yi Jun Yi Da Xue Xue Bao (J First Mil Med Univ)2005;25:1054–1055.
23.
HigginsJPTSallyG. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 March 2011. Available at: http://handbook.cochrane.org/(accessed December 2015).
24.
MoherDLiberatiATetzlaffJAltmanDG.PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg2010;8:336–341.
25.
HallJDudgeonBGuthrieM.Validity of clinical measures of shoulder subluxation in adults with poststroke hemiplegia. Am J Occup Ther1995;49:526–533.
26.
SanfordJMorelandJSwansonLRStratfordPWGowlandC.Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke. Phys Ther1993;73:447–454.
27.
BobathB.Adult hemiplegia: Evaluation and Treatment. 2nd ed.London: Heinemann Medical Books,1978.
28.
CarrJHShepherdRBNordholmLLynneD.Investigation of a new motor assessment scale for stroke patients. Phys Ther1985;65:175–180.
29.
DemeurisseGDemolORobayeE.Motor evaluation in vascular hemiplegia. Eur Neurol1980;19:382–389.
30.
HigginsJPAltmanDGGøtzschePCJüniPMoherDOxmanADet al. Cochrane Bias Methods Group; Cochrane Statistical Methods Group. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ2011;343:d5928.
FoleyNCTeasellRWBhogalSKSpeechleyMR.Stroke Rehabilitation Evidence-Based Review: methodology. Top Stroke Rehabil2003;10:1–7.
33.
Consumers and Communication Group resources for authors. Cochrane Consumers and Communication. Cccrgcochraneorg. 2016. Available at: http://cccrg.cochrane.org/author-resources (accessed 12 October 2015).
34.
HozoSPDjulbegovicBHozoI.Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol2005;5:13.
35.
KwakkelGKollenBLindemanE.Understanding the pattern of functional recovery after stroke: facts and theories. Restor Neurol Neurosci2004;22:281–299.
36.
FoleyNCTeasellRWBhogalSKDohertyTSpeechleyMR.The efficacy of stroke rehabilitation: a qualitative review. Top Stroke Rehabil2003;10:1–18.
37.
RevMan, Version 5.3. Copenhagen. The Nordic Cochrane Centre, The Cochrane Collaboration, Oxford, UK, 2014.
38.
BowmanBRBakerLLWatersRL.Positional Feedback and electrical stimulation: An automated treatment for the hemiplegic wrist. Arch Phys Med Rehabil1979;60:497–502.
39.
BakerLLYehCWilsonDWatersRL.Electrical stimulation of wrist and fingers for hemiplegic patients. Phys Ther1979;59:1495–1400.
40.
PradaGTallisR.Treatment of the neglect syndrome in stroke patients using a contingency electrical stimulator. Clin Rehab1995;9:304–313.
41.
HughesAMFreemanCTBurridgeJHChappellPHLewinPLRogersE.Feasibility of iterative learning control mediated by functional electrical stimulation for reaching after stroke. Neurorehabil Neural Repair200923:559–568.
42.
ChanMKTongRKChungKY.Bilateral upper limb training with functional electric stimulation in patients with chronic stroke. Neurorehabil Neural Repair2009;23:357–365.
43.
HesseSWernerCPohlMMehrholzJPuzichUKrebsHI.Mechanical arm trainer for the treatment of the severely affected arm after a stroke: a single-blinded randomized trial in two centers. American Journal of Physical Medicine & Rehabilitation. 2008; 87:779–788.
44.
BalmasedaMTJrFatehiMTKoozekananiSHSheppardJS.Burns in functional electric stimulation: two case reports. Arch Phys Med Rehabil1987;68:452–453.
45.
SteckerMMPattersonTNethertonBL.Mechanisms of electrode induced injury. Part 1: theory. Am J Electroneurodiagnostic Technol2006;46:315–342.
46.
SasakiKMatsunagaTTomiteTYoshikTShimadaY.Effect of electrical stimulation therapy on upper extremity functional recovery and cerebral cortical changes in patients with chronic hemiplegia. Biomed Res2012;33:89–96.
47.
RosewillarnSSMalhotraSRoggeCJonesPPandyanA.Can surface Neuromusuclar Electrical stimulation of the wrist and hand combined with routine therapy facilitate recovery of arm function in patients with stroke?Arch Phys Med Rehabil2012;93:1715–1721.
48.
HaraSObayashSTsujiuchiKMuraokaY.The effects of electromyopraphy-controlled functional electrical stimulation on upper extremity function and cortical perfusion in stroke patients. Clin Neurophysiol2013; 124: 2008–2015.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
