Application of neuromuscular electrical stimulation during immobilization of extremities for musculoskeletal conditions: A scoping review.
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BACKGROUND: Neuromuscular electrical stimulation (NMES) is effective at improving recovery after periods of disuse. It is unclear if NMES can be applied during periods of immobilization for musculoskeletal conditions to mitigate resulting impairments from disuse. The aim of this scoping review is to describe the state of the literature applying NMES during immobilization to treat upper and lower extremity musculoskeletal conditions. METHODS: A literature search was conducted in October 2023 combining keywords related to "neuromuscular electrical stimulation", "musculoskeletal", and "immobilization" in Pubmed, Scopus, CINAHL, and Proquest Dissertations and Thesis with an English filter. Articles were included if an upper or lower extremity was immobilized during the NMES application and NMES was applied with surface electrodes. Articles were excluded if NMES was applied outside of the immobilization period, participants had a neurological condition that could impair neuromotor pathways, and/or electrical stimulation was applied invasively. Data extracted included study design, sample characteristics, immobilization protocol, intervention, stimulation parameters, outcome measures, and results. The Joanna Briggs Institute (JBI) Critical Appraisal Tools for Cohort Studies was used to assess quality for all included studies. RESULTS: Six studies with 127 participants were included. The musculoskeletal conditions addressed were anterior cruciate ligament repair and tibia fracture. Immobilization procedures maintain knee flexion between 10 and 45° for four to six weeks. NMES was applied through holes cut in the casts. NMES duration ranged from 40 minutes to 8 hours a day with an alternating current ramping up over 0.4 to 4 seconds (s), the contraction duration between two and 20 s, and rest times between five and 50 s. NMES application improved quadriceps atrophy and strength outcomes in four studies. DISCUSSION: The body of literature is limited to two patient populations, only a small sample of cohort studies, physiological outcomes, and all studies were published before 1989. The models used in these studies are outdated, so new models (i.e. distal radius fracture) are proposed to investigate NMES application during immobilization in musculoskeletal populations. This study highlights a substantial gap in the literature and that further investigation into NMES application during immobilization for musculoskeletal conditions is warranted.
