School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.
Physiother Theory Pract. 2022 Dec;38(12):1857-1875. doi: 10.1080/09593985.2021.1894620. Epub 2021 Apr 23.
Pain and muscles weakness often delays regaining independent mobility following hip fracture surgery. Electrical stimulation may relieve pain and improve muscle strength and function.
To systematically review and evaluate available literature examining the effectiveness of using electrical stimulation to promote clinical outcomes after hip fractures.
Two researchers independently searched MEDLINE, CINAHL, EMBASE, Web of Science, Cochrane Reviews, Physiotherapy Evidence Database, and PsycInfo from inception to July 1, 2018, with no restrictions. The quality and fidelity of the included interventions were assessed, and expert consultation was conducted to help explain the results.
We identified 432 records through database searching. Initial screening indicated 24 articles were appropriate for full-text review, and four articles met the inclusion criteria. In included studies, electrical stimulation (i.e. TENS) reduced pain (mean difference (MD) = 3.3 points on 10-point Visual Analogue Scale, < .001), improved range of motion (ROM) (MD: 25.7°, < .001), and accelerated functional recovery immediately after hip fracture ( < .001). Conflicting evidence existed when using neuromuscular electrical stimulation to improve muscle strength and other functional outcomes (e.g. mobility); however, nine experts advised that longer-term interventions might be necessary to achieve significant improvment in muscle strength.
Available evidence, albeit limited, supports the early application of noninvasive electrical stimulation (e.g. TENS) for improving clinical outcomes (i.e. reducing pain, improving ROM, and accelerating functional recovery after hip fractures). We could not find conclusive evidence on the effectiveness of using electrical stimulation to improve muscle strength. This review establishes the need for future additional high-quality trials in this field.
疼痛和肌肉无力常常会延迟髋部骨折手术后恢复独立活动的能力。电刺激可能有助于缓解疼痛并改善肌肉力量和功能。
系统地回顾和评估现有文献，以研究电刺激在促进髋部骨折后临床结果方面的有效性。
两位研究人员独立检索了 MEDLINE、CINAHL、EMBASE、Web of Science、Cochrane 评价、物理治疗证据数据库和 PsycInfo，检索时间从建库至 2018 年 7 月 1 日，无任何限制。评估了纳入干预措施的质量和保真度，并进行了专家咨询以帮助解释结果。
我们通过数据库检索共确定了 432 条记录。初步筛选表明，24 篇文章适合进行全文审查，其中 4 篇文章符合纳入标准。在纳入的研究中，电刺激（即 TENS）可减轻疼痛（10 分制视觉模拟量表的平均差值（MD）为 3.3 分， <.001），改善活动范围（MD：25.7°， <.001），并在髋部骨折后立即加速功能恢复（ <.001）。使用神经肌肉电刺激来改善肌肉力量和其他功能结果（如移动性）的证据存在冲突；然而，9 位专家建议，可能需要进行更长期的干预才能使肌肉力量得到显著改善。
尽管证据有限，但现有证据支持早期应用无创性电刺激（如 TENS）来改善临床结果（即减轻疼痛、改善活动范围并加速髋部骨折后的功能恢复）。我们无法找到使用电刺激来改善肌肉力量的有效性的确凿证据。这篇综述确定了在该领域进行更多高质量试验的必要性。
