A narrative review of the use of neuromuscular electrical stimulation in individuals with diabetic foot ulceration
File(s)
Author(s)
Goodall, Richard
Langridge, Benjamin
Lane, Tristan
Davies, alun
Shalhoub, Joseph
Type
Journal Article
Abstract
This review aims to summarise the evidence reported on the use of neuromuscular electrical stimulation (NMES) in individuals with diabetic foot ulceration (DFU).
A systematic search of EMBASE and MEDLINE databases was performed in February 2019, using search terms relating to the domains DFU and NMES. All primary evidence assessing outcomes of NMES in DFU were included.
Of 344 references obtained from database searching, seven met the inclusion criteria and included a total of 140 participants, 77 of whom had DFU. All included studies used prospective designs. Two studies demonstrated improvements in chronic ulcer healing with NMES use, however in each study, only three of the included participants had DFU and subgroup analyses based on ulcer aetiology was omitted. The remaining five studies were produced by the same research group and positive effects of NMES (in combination with heat therapy) on DFU healing were consistently demonstrated. They reported significantly better healing rates with NMES in DFU than in non-diabetic wounds of a similar grade (Healing rate: 70.0±32.3% in DFU vs. 38.4±22.3% in non diabetic ulcers (p<0.01)). These studies did not provide data assessing the isolated effects of NMES without concomitant heat exposure. Data on device tolerability and compliance were lacking.
The existing data supports a potential role for NMES in individuals with DFU, however the identified studies inadequately controlled for confounding and were underpowered. Given the significant morbidity and mortality associated with DFU, higher quality evidence is needed to assess the adjunctive role for NMES in this group.
A systematic search of EMBASE and MEDLINE databases was performed in February 2019, using search terms relating to the domains DFU and NMES. All primary evidence assessing outcomes of NMES in DFU were included.
Of 344 references obtained from database searching, seven met the inclusion criteria and included a total of 140 participants, 77 of whom had DFU. All included studies used prospective designs. Two studies demonstrated improvements in chronic ulcer healing with NMES use, however in each study, only three of the included participants had DFU and subgroup analyses based on ulcer aetiology was omitted. The remaining five studies were produced by the same research group and positive effects of NMES (in combination with heat therapy) on DFU healing were consistently demonstrated. They reported significantly better healing rates with NMES in DFU than in non-diabetic wounds of a similar grade (Healing rate: 70.0±32.3% in DFU vs. 38.4±22.3% in non diabetic ulcers (p<0.01)). These studies did not provide data assessing the isolated effects of NMES without concomitant heat exposure. Data on device tolerability and compliance were lacking.
The existing data supports a potential role for NMES in individuals with DFU, however the identified studies inadequately controlled for confounding and were underpowered. Given the significant morbidity and mortality associated with DFU, higher quality evidence is needed to assess the adjunctive role for NMES in this group.
Date Issued
2020-09-01
Date Acceptance
2019-12-03
Citation
International Journal of Lower Extremity Wounds, 2020, 19 (3), pp.242-250
ISSN
1534-7346
Publisher
SAGE Publications
Start Page
242
End Page
250
Journal / Book Title
International Journal of Lower Extremity Wounds
Volume
19
Issue
3
Copyright Statement
© The Author(s) 2020. The final, definitive version of this paper has been published in International Journal of Lower Extremity Wounds by Sage Publications Ltd. All rights reserved. It is available at: https://journals.sagepub.com/doi/10.1177/1534734619898978
Subjects
Science & Technology
Life Sciences & Biomedicine
Dermatology
Surgery
diabetic foot ulcers
electrical stimulation
chronic wounds
NERVE-STIMULATION
CHRONIC WOUNDS
LOCAL HEAT
ULCERS
chronic wounds
diabetic foot ulcers
electrical stimulation
Dermatology & Venereal Diseases
1103 Clinical Sciences
Publication Status
Published
Date Publish Online
2020-01-30