The Third Clinical Medical College, Zhejiang Chinese Medical University, No. 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang Province, China.
Department of Rehabilitation, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Hangzhou, Zhejiang, China.
J Neuroeng Rehabil. 2024 Sep 18;21(1):164. doi: 10.1186/s12984-024-01462-2.
Improper gait patterns, impaired balance and foot drop consistently plague stroke survivors, preventing them from walking independently and safely. Neuromuscular electrical stimulation (NMES) technology can help patients reactivate their muscles and regain motor coordination. This study aims to systematically review and summarize the evidence for the potential benefits of NMES on the improvement of gait patterns after stroke.
PubMed, Cochrane Library, Embase, Science Direct and Web of Science were systematically searched until April 2024, to identify randomized controlled trials with the following criteria: stroke survivors as participants; NMES as intervention; conventional rehabilitation as a comparator; and gait assessment, through scales or quantitative parameters, as outcome measures.
29 publications involving 1711 patients met the inclusion criteria. Meta-analysis showed no significant differences in Ten-meter walk test, Fugl-Meyer assessment lower extremity, Modified Ashworth Assessment and asymmetry between the NMES group and the control group. Besides, NMES was associated with changes in outcome indicators such as quantitative gait analysis speed [SMD = 0.53, 95% CI (0.20, 0.85), P = 0.001], cadence [SMD = 0.76, 95% CI (0.32, 1.20), P = 0.0008], affected side step length [SMD = 0.73, 95% CI (0.16, 1.31), P = 0.01], angle of ankle dorsiflexion [WMD = 1.57, 95% CI (0.80, 2.33), P < 0.0001], Six-Minute Walk Test [WMD = 14.83, 95% CI (13.55, 16.11), P<0.00001]. According to the PEDro scale, 21 (72.4%) studies were of high quality and 8 were of moderate quality (27.6%).
Taken together, the review synthesis indicated that NMES might play a potential role in stroke-induced walking dysfunction. And NMES may be superior for survivors in the chronic phase than the acute and subacute phases, and the efficacy of short sessions received by patients was greater than that of those who participated in a longer session. Additionally, further comparisons of the effects of NMES with different types or stimulation frequencies may provide unexpected benefits.
简介：步态异常、平衡受损和足下垂一直困扰着中风幸存者，使他们无法独立、安全地行走。神经肌肉电刺激 (NMES) 技术可以帮助患者重新激活肌肉并恢复运动协调能力。本研究旨在系统回顾和总结 NMES 对改善中风后步态模式的潜在益处的证据。
证据收集：系统检索了 PubMed、Cochrane 图书馆、Embase、Science Direct 和 Web of Science，截至 2024 年 4 月，以确定符合以下标准的随机对照试验：中风幸存者为参与者；NMES 为干预措施；常规康复为对照；步态评估，通过量表或定量参数作为结局测量指标。
证据综合：29 篇涉及 1711 名患者的文献符合纳入标准。Meta 分析显示，在 10 米步行测试、Fugl-Meyer 下肢评估、改良 Ashworth 评估和左右侧不对称性方面，NMES 组与对照组之间无显著差异。此外，NMES 与定量步态分析速度[SMD=0.53，95%置信区间（0.20，0.85），P=0.001]、步频[SMD=0.76，95%置信区间（0.32，1.20），P=0.0008]、患侧步长[SMD=0.73，95%置信区间（0.16，1.31），P=0.01]、踝关节背屈角度[WMD=1.57，95%置信区间（0.80，2.33），P<0.0001]和 6 分钟步行测试[WMD=14.83，95%置信区间（13.55，16.11），P<0.00001]等结局指标的变化相关。根据 PEDro 量表，21 项（72.4%）研究质量较高，8 项（27.6%）研究质量中等。
结论：综上所述，综述综合分析表明，NMES 可能在中风引起的步行功能障碍中发挥潜在作用。并且 NMES 可能对慢性期的幸存者比急性期和亚急性期更有效，且患者接受的短疗程效果大于长疗程。此外，对不同类型或刺激频率的 NMES 效果进行进一步比较可能会带来意想不到的益处。
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