Chair of Healthcare Management and Health Services Research, University of Bayreuth, Parsifalstraße 25, 95445, Bayreuth, Bavaria, Germany.
Kuratorium Für Dialyse Und Nierentransplantation (KfH), Nierenzentrum München-Giesing, Munich, Germany.
BMC Nephrol. 2023 Aug 23;24(1):246. doi: 10.1186/s12882-023-03283-2.
Sarcopenia is highly prevalent in haemodialysis (HD) patients and linked to a poor prognosis regarding comorbidities and premature mortality. Previous studies assessed the effects of neuromuscular electrical stimulation in haemodialysis patients. This study adds to the relevance of neuromuscular electrical stimulation (NMES) applications combined with a virtual reality (VR) distraction to increase intensity, dosage, and efficiency of NMES and slow sarcopenia progression in HD patients.
We conducted a 12-week multicenter prospective randomised controlled trial. The patients were randomly assigned to one of the three groups: neuromuscular electrical stimulation with or without combined virtual reality distraction or control group.
The final analysis included 32 haemodialysis patients (mean age of 68 ± 10 years, 26 men). Interaction effects between groups and time (12 weeks) were significant regarding serum albumin levels (p = 0.008) and left quadriceps femoris muscle (QFM) force (p = 0.026). Both endpoints were increased in the NMES compared to the CO group at the end of the intervention. The NMES group increased serum albumin levels significantly after 12 weeks. The main effect of time was an increase in mean right QFM force between beginning and end of the intervention (p = 0.021). Functional capacity improved after 12 weeks in the NMES and NMES + VR but not in the control group, with a significant difference between the three groups (p = 0.022). Weight and body mass index increased in the NMES and NMES + VR groups, albeit not significantly. The effects of VR distraction on NMES efficiency were inconclusive.
Intradialytic NMES increases serum albumin level, functional capacity, muscle strength in lower limb and in tendency weight and body mass index of HD patients. Effects on VR distraction are inconclusive. Large-scaled follow-up studies on integrated sports programs with NMES and active training in combination with VR as distraction and motivation accelerator are needed.
German Clinical Trial Register: DRKS00029276 (Retrospectively registered: 30/06/2022).
肌少症在血液透析（HD）患者中非常普遍，与合并症和过早死亡的预后不良有关。以前的研究评估了神经肌肉电刺激对血液透析患者的影响。本研究增加了神经肌肉电刺激（NMES）与虚拟现实（VR）分散注意力相结合的应用的相关性，以增加 NMES 的强度、剂量和效率，并减缓 HD 患者的肌少症进展。
我们进行了一项为期 12 周的多中心前瞻性随机对照试验。患者被随机分配到三组之一：NMES 加或不加联合虚拟现实分散注意力或对照组。
最终分析包括 32 名血液透析患者（平均年龄 68±10 岁，26 名男性）。组间和时间（12 周）的交互作用在血清白蛋白水平（p=0.008）和左股四头肌（QFM）力量（p=0.026）方面有显著差异。在干预结束时，NMES 组与 CO 组相比，这两个终点都有所增加。NMES 组在 12 周后血清白蛋白水平显著增加。时间的主要影响是干预开始和结束时右 QFM 力量的平均值增加（p=0.021）。12 周后，NMES 和 NMES+VR 组的功能能力均有所改善，但对照组无明显改善，三组之间存在显著差异（p=0.022）。NMES 和 NMES+VR 组的体重和体重指数增加，但无统计学意义。虚拟现实分散注意力对 NMES 效率的影响尚无定论。
血液透析过程中的 NMES 可提高血清白蛋白水平、功能能力、下肢肌肉力量，以及 HD 患者的体重和体重指数，呈趋势性增加。虚拟现实分散注意力的效果尚无定论。需要进行更大规模的后续研究，将 NMES 与主动训练相结合，结合 VR 作为分散注意力和激励加速器的综合运动方案。
德国临床试验注册处：DRKS00029276（回顾性注册：2022 年 6 月 30 日）。
