Abdelhamed Ahmed Ibrahim, Mortada Hossam, Hendawy Ahmed, Elfeky Amr, Kamel Roshdy M, Elshennawy Shorouk
Faculty of Physical Therapy, Misr University for Science and Technology, 6th of October, Giza, Egypt.
Biomechanics Unit, Basic Sciences Department, Faculty of Physical Therapy, Galala University, Suez, Egypt.
BMC Musculoskelet Disord. 2025 Aug 9;26(1):770. doi: 10.1186/s12891-025-09029-5.
Patellofemoral pain (PFP) is a chronic musculoskeletal disorder, with Neuromuscular electrical stimulation (NMES) often used as a complementary treatment option, however no definitive evidence supports its benefits. This systematic review aimed to evaluate the efficacy of adding NMES to exercise programs for treating PFP.
PubMed, Cochrane CENTRAL, Web of Science, Scopus, PEDro, ClinicalTrails.gov and International Clinical Trials Registry Platform were searched up to July 2024 for randomized controlled trials (RCTs) investigating the effectiveness of NMES in people with PFP. Two researchers independently screened titles and abstracts; another pair filtered full-text articles. The studies had to report pain, functionality, and strength as outcome measures. The risk of bias was assessed using the revised Cochrane Collaboration tool (RoB 2.0). Meta-analysis was conducted using RevMan 5.4.1 software, and the quality of evidence was evaluated using the GRADE approach.
Eleven RCTs, involving 571 participants, were included. Most of the studies were of high risk of bias. NMES combined with exercise was favored in the long course for improving function (SMD: 3.74, 95% CI 1.35, 5.81; P = 0.0004) and quadriceps muscle strength (SMD: 0.53, 95% CI 0.18, 0.89; P = 0.003) compared to exercise; however, it did not differ from exercise in relieving pain and improving EMG activity level, and participation. The GRADE certainty rating of the results was rated as very low mostly due to inconsistency and high risk of bias.
Very low certainty of evidence suggests that adding NMES to an exercise program may improve the knee joint function and quadriceps strength with treatment courses of six weeks or more in patients with PFP, but it is not superior to control for reliving pain and improving EMG activity, activity level, and participation. Larger, high-quality RCTs on the long-term are needed to reach an incisive conclusion.
The protocol was registered at Open Science Framework Register under https://doi.org/10.17605/OSF.IO/Y2JUZ .
髌股疼痛（PFP）是一种慢性肌肉骨骼疾病，神经肌肉电刺激（NMES）常作为一种辅助治疗选择，但尚无确凿证据支持其益处。本系统评价旨在评估在运动方案中添加NMES治疗PFP的疗效。
截至2024年7月，检索了PubMed、Cochrane CENTRAL、Web of Science、Scopus、PEDro、ClinicalTrails.gov和国际临床试验注册平台，以查找调查NMES对PFP患者有效性的随机对照试验（RCT）。两名研究人员独立筛选标题和摘要；另一对人员筛选全文文章。这些研究必须将疼痛、功能和力量作为结局指标进行报告。使用修订后的Cochrane协作工具（RoB 2.0）评估偏倚风险。使用RevMan 5.4.1软件进行荟萃分析，并使用GRADE方法评估证据质量。
纳入了11项RCT，涉及571名参与者。大多数研究存在高偏倚风险。与单纯运动相比，长期来看，NMES联合运动在改善功能（标准化均数差：3.74，95%置信区间1.35，5.81；P = 0.0004）和股四头肌力量（标准化均数差：0.53，95%置信区间0.18，0.89；P = 0.003）方面更具优势；然而，在缓解疼痛、改善肌电图活动水平和参与度方面，与单纯运动没有差异。结果的GRADE确定性评级大多被评为极低，主要是由于不一致性和高偏倚风险。
证据确定性极低表明，在PFP患者中，在运动方案中添加NMES可能在六周或更长疗程时改善膝关节功能和股四头肌力量，但在缓解疼痛、改善肌电图活动、活动水平和参与度方面并不优于对照组。需要更大规模、高质量的长期RCT才能得出确切结论。
该方案已在开放科学框架注册库（https://doi.org/10.17605/OSF.IO/Y2JUZ ）注册。
