Skip to content
naulon
Get started

No retraction, correction or concern found when last checked on Oct 27, 2026.

Neuromuscular electrical stimulation for preventing skeletal-muscle weakness and wasting in critically ill patients: a systematic review

Nicola A Maffiuletti, Marc Roig, Eleftherios Karatzanos and 1 more

BMC Medicine · 2013 · Systematic review

doi:10.1186/1741-7015-11-137

Abstract

Background. Neuromuscular electrical stimulation (NMES) therapy may be useful in early musculoskeletal rehabilitation during acute critical illness. The objective of this systematic review was to evaluate the effectiveness of NMES for preventing skeletal-muscle weakness and wasting in critically ill patients, in comparison with usual care.

Methods. We searched PubMed, CENTRAL, CINAHL, Web of Science, and PEDro to identify randomized controlled trials exploring the effect of NMES in critically ill patients, which had a well-defined NMES protocol, provided outcomes related to skeletal-muscle strength and/or mass, and for which full text was available. Two independent reviewers extracted data on muscle-related outcomes (strength and mass), and participant and intervention characteristics, and assessed the methodological quality of the studies. Owing to the lack of means and standard deviations (SDs) in some studies, as well as the lack of baseline measurements in two studies, it was impossible to conduct a full meta-analysis. When means and SDs were provided, the effect sizes of individual outcomes were calculated, and otherwise, a qualitative analysis was performed.

Results. The search yielded 8 eligible studies involving 172 patients. The methodological quality of the studies was moderate to high. Five studies reported an increase in strength or better preservation of strength with NMES, with one study having a large effect size. Two studies found better preservation of muscle mass with NMES, with small to moderate effect sizes, while no significant benefits were found in two other studies.

Conclusions. NMES added to usual care proved to be more effective than usual care alone for preventing skeletal-muscle weakness in critically ill patients. However, there is inconclusive evidence for its benefit in prevention of muscle wasting.

References 66

  1. 1.

    Latronico N Bolton CF Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysisLancet Neurol2011 10931941

    Not in our library10.1016/s1474-4422(11)70178-8

  2. 2.

    Puthucheary Z Montgomery H Moxham J Harridge S Hart N Structure to function: muscle failure in critically ill patientsJ Physiol2010 58846414648

    Not in our library10.1113/jphysiol.2010.197632

  3. 3.

    de Jonghe B Lacherade JC Sharshar T Outin H Intensive care unit-acquired weakness: risk factors and preventionCrit Care Med2009 37S309315

    Not in our library10.1097/ccm.0b013e3181b6e64c

  4. 4.

    De Jonghe B Sharshar T Hopkinson N Outin H Paresis following mechanical ventilationCurr Opin Crit Care2004 104752

    Not in our library10.1097/00075198-200402000-00008

  5. 5.

    Griffiths RD Palmer TE Helliwell T MacLennan P MacMillan RR Effect of passive stretching on the wasting of muscle in the critically illNutrition1995 11428432

    Not in our library

  6. 6.

    Reid CL Campbell IT Little RA Muscle wasting and energy balance in critical illnessClin Nutr2004 23273280

    Not in our library10.1016/s0261-5614(03)00129-8

  7. 7.

    De Jonghe B Bastuji-Garin S Durand MC Malissin I Rodrigues P Cerf C Outin H Sharshar T Respiratory weakness is associated with limb weakness and delayed weaning in critical illnessCrit Care Med2007 3520072015

    Not in our library10.1097/01.ccm.0000281450.01881.d8

  8. 8.

    Edbrooke DL Minelli C Mills GH Iapichino G Pezzi A Corbella D Jacobs P Lippert A Wiis J Pesenti A Implications of ICU triage decisions on patient mortality: a cost-effectiveness analysisCrit Care2011 15R56

    Not in our library10.1186/cc10029

  9. 9.

    Leijten FS Harinck-de Weerd JE Poortvliet DC de Weerd AW The role of polyneuropathy in motor convalescence after prolonged mechanical ventilationJAMA1995 27412211225

    Not in our library10.1001/jama.1995.03530150045032

  10. 10.

    Nanas S Kritikos K Angelopoulos E Siafaka A Tsikriki S Poriazi M Kanaloupiti D Kontogeorgi M Pratikaki M Zervakis D Predisposing factors for critical illness polyneuromyopathy in a multidisciplinary intensive care unitActa Neurol Scand2008 118175181

    Not in our library10.1111/j.1600-0404.2008.00996.x

  11. 11.

    Herridge MS Tansey CM Matte A Tomlinson G Diaz-Granados N Cooper A Guest CB Mazer CD Mehta S Stewart TE Functional disability 5 years after acute respiratory distress syndromeN Engl J Med2011 36412931304

    Not in our library10.1056/nejmoa1011802

  12. 12.

    Fletcher SN Kennedy DD Ghosh IR Misra VP Kiff K Coakley JH Hinds CJ Persistent neuromuscular and neurophysiologic abnormalities in long-term survivors of prolonged critical illnessCrit Care Med2003 3110121016

    Not in our library10.1097/01.ccm.0000053651.38421.d9

  13. 13.

    Burtin C Clerckx B Robbeets C Ferdinande P Langer D Troosters T Hermans G Decramer M Gosselink R Early exercise in critically ill patients enhances short-term functional recoveryCrit Care Med2009 3724992505

    Not in our library10.1097/ccm.0b013e3181a38937

  14. 14.

    Schweickert WD Pohlman MC Pohlman AS Nigos C Pawlik AJ Esbrook CL Spears L Miller M Franczyk M Deprizio D Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trialLancet2009 37318741882

    Not in our library10.1016/s0140-6736(09)60658-9

  15. 15.

    Thomsen GE Snow GL Rodriguez L Hopkins RO Patients with respiratory failure increase ambulation after transfer to an intensive care unit where early activity is a priorityCrit Care Med2008 3611191124

    Not in our library10.1097/ccm.0b013e318168f986

  16. 16.

    Puthucheary Z Harridge S Hart N Skeletal muscle dysfunction in critical care: Wasting, weakness, and rehabilitation strategiesCrit Care Med2010 38S676S682

    Not in our library10.1097/ccm.0b013e3181f2458d

  17. 17.

    Needham DM Truong AD Fan E Technology to enhance physical rehabilitation of critically ill patientsCrit Care Med2009 37S436441

    Not in our library10.1097/ccm.0b013e3181b6fa29

  18. 18.

    Truong AD Fan E Brower RG Needham DM Bench-to-bedside review: mobilizing patients in the intensive care unit–from pathophysiology to clinical trialsCrit Care2009 13216

    Not in our library10.1186/cc7885

  19. 19.
    Electrical muscle stimulation preserves the muscle mass of critically ill patients: a randomized study · 2009
    No notice
  20. 20.

    Lee CM Fan E ICU-acquired weakness: what is preventing its rehabilitation in critically ill patients?BMC Med2012 10115

    Not in our library10.1186/1741-7015-10-115

  21. 21.

    Maffiuletti NA Physiological and methodological considerations for the use of neuromuscular electrical stimulationEur J Appl Physiol2010 110223234

    Not in our library10.1007/s00421-010-1502-y

  22. 22.

    Roig M Reid WD Electrical stimulation and peripheral muscle function in COPD: a systematic reviewRespir Med2009 103485495

    Not in our library10.1016/j.rmed.2008.11.008

  23. 23.

    Gibson JN Smith K Rennie MJ Prevention of disuse muscle atrophy by means of electrical stimulation: maintenance of protein synthesisLancet1988 2767770

    Not in our library10.1016/s0140-6736(88)92417-8

  24. 24.

    Gerovasili V Tripodaki E Karatzanos E Pitsolis T Markaki V Zervakis D Routsi C Roussos C Nanas S Short-term systemic effect of electrical muscle stimulation in critically iII patientsChest2009 13612491256

    Not in our library10.1378/chest.08-2888

  25. 25.
    Electrical muscle stimulation preserves the muscle mass of critically ill patients: a randomized study · 2009
    No notice
  26. 26.

    Laghi F Jubran A Treating the septic muscle with electrical stimulationsCrit Care Med2011 39585586

    Not in our library10.1097/ccm.0b013e31820e2f6f

  27. 27.

    Kho ME Truong AD Brower RG Palmer JB Fan E Zanni JM Ciesla ND Feldman DR Korupolu R Needham DM Neuromuscular electrical stimulation for intensive care unit-acquired weakness: protocol and methodological implications for a randomized, sham-controlled, phase II trialPhys Ther2012 9215641579

    Not in our library10.2522/ptj.20110437

  28. 28.

    Maddocks M Gao W Higginson IJ Wilcock A Neuromuscular electrical stimulation for muscle weakness in adults with advanced diseaseCochrane Database Syst Rev2011 11CD009419

    Not in our library10.1002/14651858.cd009419.pub2

  29. 29.
    Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement · 2009
    No notice
  30. 30.

    de Morton NA The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic studyAust J Physiother2009 55129133

    Not in our library10.1016/s0004-9514(09)70043-1

  31. 31.

    Maher CG Sherrington C Herbert RD Moseley AM Elkins M Reliability of the PEDro scale for rating quality of randomized controlled trialsPhys Ther2003 83713721

    Not in our library

  32. 32.

    Roig M Shadgan B Reid WD Eccentric exercise in patients with chronic health conditions: a systematic reviewPhysiother Can2008 60146160

    Not in our library10.3138/physio.60.2.146

  33. 33.

    van Tulder M Furlan A Bombardier C Bouter L Updated method guidelines for systematic reviews in the cochrane collaboration back review groupSpine (Phila Pa 1976)2003 2812901299

    Not in our library10.1097/01.brs.0000065484.95996.af

  34. 34.

    Field A Discovering statistics using SPSS2005 2London: SAGE156

    Not in our library

  35. 35.

    Karatzanos E Gerovasili V Zervakis D Tripodaki ES Apostolou K Vasileiadis I Papadopoulos E Mitsiou G Tsimpouki D Routsi C Electrical muscle stimulation: an effective form of exercise and early mobilization to preserve muscle strength in critically ill patientsCrit Care Res Pract2012 2012432752

    Not in our library10.1155/2012/432752

  36. 36.
    Electrical muscle stimulation prevents critical illness polyneuromyopathy: a randomized parallel intervention trial · 2010
    No notice
  37. 37.
    Estimating the mean and variance from the median, range, and the size of a sample · 2005
    No notice
  38. 38.

    Cohen J Statistical methods for meta-analysis1998 San Diego: Academic Press

    Not in our library

  39. 39.

    Rodriguez P Bonelli I Setten M Attie S Maskin P Kozima S Valentini R Electric neuromuscular stimulation for prevention of ICU-acquired paresis in patients with severe sepsisIntensive Care Med2009 35133133

    Not in our library

  40. 40.

    Schneider JB Weber-Carstens S Bierbrauer J Marg A Olbricht C Hasani H Spuler S Electrical muscle stimulation in early severe critical illness prevents type 2 fiber atrophyNeuromuscul Disord2011 21744744

    Not in our library

  41. 41.

    Meesen RLJ Dendale P Cuypers K Berger J Hermans A Thijs H Levin O Neuromuscular electrical stimulation as a possible means to prevent muscle tissue wasting in artificially ventilated and sedated patients in the intensive care unit: a pilot studyNeuromodulation2010 13315321

    Not in our library10.1111/j.1525-1403.2010.00294.x

  42. 42.

    Bouletreau P Patricot MC Saudin F Guiraud M Mathian B Effects of intermittent electrical stimulations on muscle catabolism in intensive care patientsJPEN J Parenter Enteral Nutr1987 11552555

    Not in our library10.1177/0148607187011006552

  43. 43.

    Abdellaoui A Prefaut C Gouzi F Couillard A Coisy-Quivy M Hugon G Molinari N Lafontaine T Jonquet O Laoudj-Chenivesse D Skeletal muscle effects of electrostimulation after COPD exacerbation: a pilot studyEur Respir J2011 38781788

    Not in our library10.1183/09031936.00167110

  44. 44.

    Gruther W Kainberger F Fialka-Moser V Paternostro-Sluga T Quittan M Spiss C Crevenna R Effects of neuromuscular electrical stimulation on muscle layer thickness of knee extensor muscles in intensive care unit patients: a pilot studyJ Rehabil Med2010 42593597

    Not in our library10.2340/16501977-0564

  45. 45.

    Poulsen JB Moller K Jensen CV Weisdorf S Kehlet H Perner A Effect of transcutaneous electrical muscle stimulation on muscle volume in patients with septic shockCrit Care Med2011 39456461

    Not in our library10.1097/ccm.0b013e318205c7bc

  46. 46.

    Rodriguez PO Setten M Maskin LP Bonelli I Vidomlansky SR Attie S Frosiani SL Kozima S Valentini R Muscle weakness in septic patients requiring mechanical ventilation: protective effect of transcutaneous neuromuscular electrical stimulationJ Crit Care2012 27e311318

    Not in our library10.1016/j.jcrc.2011.04.010

  47. 47.

    Zanotti E Felicetti G Maini M Fracchia C Peripheral muscle strength training in bed-bound patients with COPD receiving mechanical ventilation: effect of electrical stimulationChest2003 124292296

    Not in our library10.1378/chest.124.1.292

  48. 48.

    Landis JR Koch GG The measurement of observer agreement for categorical dataBiometrics1977 33159174

    Not in our library10.2307/2529310

  49. 49.

    Rabe KF Hurd S Anzueto A Barnes PJ Buist SA Calverley P Fukuchi Y Jenkins C Rodriguez-Roisin R van Weel C Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summaryAm J Respir Crit Care Med2007 176532555

    Not in our library10.1164/rccm.200703-456so

  50. 50.

    Maffiuletti NA Herrero AJ Jubeau M Impellizzeri FM Bizzini M Differences in electrical stimulation thresholds between men and womenAnn Neurol2008 63507512

    Not in our library10.1002/ana.21346

  51. 51.

    Bednarik J Vondracek P Dusek L Moravcova E Cundrle I Risk factors for critical illness polyneuromyopathyJ Neurol2005 252343351

    Not in our library10.1007/s00415-005-0654-x

  52. 52.

    Harper NJ Greer R Conway D Neuromuscular monitoring in intensive care patients: milliamperage requirements for supramaximal stimulationBr J Anaesth2001 87625627

    Not in our library10.1093/bja/87.4.625

  53. 53.

    Maffiuletti NA Minetto MA Farina D Bottinelli R Electrical stimulation for neuromuscular testing and training: state-of-the art and unresolved issuesEur J Appl Physiol2011 11123912397

    Not in our library10.1007/s00421-011-2133-7

  54. 54.

    Vivodtzev I Debigare R Gagnon P Mainguy V Saey D Dube A Pare ME Belanger M Maltais F Functional and muscular effects of neuromuscular electrical stimulation in patients with severe COPD: a randomized clinical trialChest2012 141716725

    Not in our library10.1378/chest.11-0839

  55. 55.

    Napolis LM Dal Corso S Neder JA Malaguti C Gimenes AC Nery LE Neuromuscular electrical stimulation improves exercise tolerance in chronic obstructive pulmonary disease patients with better preserved fat-free massClinics (Sao Paulo)2011 66401406

    Not in our library10.1590/s1807-59322011000300006

  56. 56.

    Vanderthommen M Duchateau J Electrical stimulation as a modality to improve performance of the neuromuscular systemExerc Sport Sci Rev2007 35180185

    Not in our library10.1097/jes.0b013e318156e785

  57. 57.

    Gobbo M Gaffurini P Bissolotti L Esposito F Orizio C Transcutaneous neuromuscular electrical stimulation: influence of electrode positioning and stimulus amplitude settings on muscle responseEur J Appl Physiol2011 11124512459

    Not in our library10.1007/s00421-011-2047-4

  58. 58.

    Sapega AA Muscle performance evaluation in orthopaedic practiceJ Bone Joint Surg Am1990 7215621574

    Not in our library

  59. 59.

    Maffiuletti NA Assessment of hip and knee muscle function in orthopaedic practice and researchJ Bone Joint Surg Am2010 92220229

    Not in our library10.2106/jbjs.i.00305

  60. 60.

    Gandevia SC Spinal and supraspinal factors in human muscle fatiguePhysiol Rev2001 8117251789

    Not in our library10.1152/physrev.2001.81.4.1725

  61. 61.

    Man WD Moxham J Polkey MI Magnetic stimulation for the measurement of respiratory and skeletal muscle functionEur Respir J2004 24846860

    Not in our library10.1183/09031936.04.00029004

  62. 62.

    Rutkove SB Electrical impedance myography: Background, current state, and future directionsMuscle Nerve2009 40936946

    Not in our library10.1002/mus.21362

  63. 63.

    Chuang LL Wu CY Lin KC Reliability, validity, and responsiveness of myotonometric measurement of muscle tone, elasticity, and stiffness in patients with strokeArch Phys Med Rehabil2012 93532540

    Not in our library10.1016/j.apmr.2011.09.014

  64. 64.

    Pisot R Narici MV Simunic B De Boer M Seynnes O Jurdana M Biolo G Mekjavic IB Whole muscle contractile parameters and thickness loss during 35-day bed restEur J Appl Physiol2008 104409414

    Not in our library10.1007/s00421-008-0698-6

  65. 65.

    Deem S Intensive-care-unit-acquired muscle weaknessRespir Care2006 5110421052discussion 1052–1043

    Not in our library

  66. 66.

    Hortobagyi T Maffiuletti NA Neural adaptations to electrical stimulation strength trainingEur J Appl Physiol2011 11124392449

    Not in our library10.1007/s00421-011-2012-2

Cited by papers we hold 5

Reads

Read by people on this page

None yet.

Checked or read by AI through naulon

None yet.

A person counts once a day per paper. We keep no cookie and no address: a reader is a hash that changes every day. Any month under five reads shows no number.

Are you an author?

Is this your paper?

Claim it to add your note and be paid when agents cite it. Free.