Stein Brazilian a meta-analysis et al published in the journal Stroke 2015 evaluates, based on 29 trials, the efficiency of electrostimulation combined or not with other types of therapies on muscle spasticity after cerebrovascular accident (CVA). The results show that patients who followed a program electrostimulation improves muscle spasticity and range of motion compared to the control group.
The Study Rationale
Stroke is the leading cause of chronic disability large in the United States. The American Heart Association estimates the prevalence of stroke to 6.8 million people, representing 2.8% of the US population according to a survey conducted between 2007 and 2010. A stroke patient severely handicapped and generates great difficulties for families. This chronic disease is a worldwide health problem.
Spasticity is one of the major consequences of stroke. It corresponds to a movement disorder resulting in intermittent muscle overactivity or permanent. The muscle contracts too hard to rest, unintentionally, intensely at the slightest stimulation and repeatedly uncontrollably. The member can then flexed be unfolded. Spasticity occur in 20% to 30% of stroke victims.
Traditional treatments include the use of an ankle-foot orthosis, physical therapies, medicines, tendon surgery and chemical neurolysis. More recently, neuromuscular electrical stimulation or electrostimulation also known has been proposed as a new method of non-drug intervention. Randomized controlled trials were carried out on the subject, a meta-analysis synthesizes.
Is the electrical stimulation effective in reducing muscle spasticity and improve range of motion after a stroke?
Brazilian meta-analysis of Stein and his colleagues chose 29 trials involving 940 participants. Only four studies were blinded to patients. The electrostimulation single or in combination with other therapies was compared to placebo or groups receiving another therapy.
The main measure concerned spasticity as assessed by the Modified Ashworth Scale. The secondary measure concerned the range of motion measured by a goniometer.
The Non-Pharmacological Intervention (NPI) assessed
In 22 studies, electrostimulation was improved muscle function and the decrease in spasticity. The frequency of the electrical stimulation was between 18 and 50 Hz with a pulse duration of 0.1 ms to 0.4 ms. In three studies, the frequency of the electrical stimulation was between 80 and 100 Hz with a pulse duration of 0.1 ms to 0.3 ms. Four studies do not describe the characteristics of electrostimulation. The duration of surgery was 3039 minutes on average. Except for one study, electrostimulation sessions took place in the office or hospital and were supervised by a trained health care professional.
Electrostimulation alone or in combination with other rehabilitation therapies is associated with spasticity reduction and an increase in range of motion compared to the control group. Nothing is said about the side effects such as pain and irritation of the skin.
What it means for Patients
Electrostimulation is an ineffective drug intervention to improve range of motion and reduce spasticity after a stroke.
What it means for Healthcare Professionals
An intervention based on the combined electrostimulation or not to other therapies reduces spasticity and improve range of motion. Electrostimulation could lead to benefits in terms of motor control and functional activity programs. Nothing is said about the side effects such as pain and irritation of the skin.
What it means for Researchers
Electrostimulation improves range of motion and reduces spasticity after a stroke. But some randomized controlled trials in this meta-analysis do not find this result. It is possible that the time between the onset of stroke and the beginning of the procedure, the time of treatment, the degree of spasticity, the degree of ability to voluntarily contract a muscle could affect the response to electrical neuromuscular stimulation. Large-scale clinical trials and impeccable methodological quality are necessary to establish its effectiveness.
What it means for Policymakers
Spasticity resulting from stroke causes chronic disability. The data from this meta-analysis provide evidence that electrical stimulation can be used as an effective non-drug intervention to improve spasticity and range of movement of patients.
Stein C, Fritsch CG, Robinson C, Sbruzzi G, Della Mea Plentz R (2015). Effects of electrical stimulation in spastic muscles after stroke: Systematic review and meta-analysis of randomized controlled trials. Stroke, 45, 2197-2205.
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Same non-pharmacological intervention
To reference this Blog en Sante © article.
Ninot G (2015). Efficacy of electrical stimulation in rehabilitation of stroke. Blog en Sante, A65.
© Copyright 2015 Gregory Ninot. All rights reserved.