ADMINISTRATION OF NEUROMUSCULAR ELECTRICAL STIMULATION TO MALNUTRITION STROKE PATIENTS IS EFFECTIVE IN PREVENTING LOWER LIMB MUSCLE ATROPHY AND IMPROVING STRENGTH

Background: Malnutrition Stroke patients are promoted muscle atrophy and muscle weakness, and the improvement of activity daily of life and physical functions is delayed. Therefore, it is necessary to prevent muscular atrophy and muscle weakness in malnutrition stroke patients.
Neuromuscular electrical stimulation(NMES) is often used to facilitate in voluntary muscle contraction. Therefore, it is an effective intervention method for preventing muscle atrophy and muscle weakness.

Purpose: This study examined whether NMES in malnutrition stroke patients is an effective intervention for muscle atrophy and muscle weakness.

Methods:  This study design was a prospective randomized single-blind trial. Inclusion criteria were selected from malnutrition stroke patients aged 65 years or older who were admitted of the convalescent stage from June 10, 2019 to April 10, 2020, after being treated at acute phase hospitals.Malnutrition stroke patients were identified using the the Global Leadership Initiative on Malnutrition and Geriatric Nutritional Risk Index. Malnutrition stroke patients (N=156) were randomized to receive either NMES applied to the quadriceps (the NMES group) or no stimulation (the Control group) in addition to a standard rehabilitation program. The NMES was administered for motor-level intensity(15 - 40 mA). And symmetrical biphasic current of 100 Hz, pulse width of 1 msec, 30 min/day, and duty cycle of 10 sec on/50 sec off , and was performed 5 days/week, for 12 weeks.
The main outcomes were assessed the muscle thickness (MT), Pennnation angle (PA), and Echo intensity (EI) of the quadriceps femoris on the affected and non-affected sides with a transverse ultrasound images. In addition, Hand held dynamometer was used to measure lower limb muscle strength on the affected and non-affected sides. Main outcomes were measured at admission and after intervention.
Two-way repeated-measures analysis of variance was used to evaluate the differences between the 2 groups. A post-hoc test using Bonferroni method.  We also calculated the effect sizes between two groups at post-intervention for all outcome, which was proposed by Cohen’s d. A P-value of <0.05 was considered to show statistical significance for all analyses.

Results: In the control group, the decrease in  affected and non-affected sides muscle atrophy progressed after 12 weeks(p < 0.05). On the other hand, the NMES groups were able to limit the rate of  affected and non-affected sides muscle atrophy within 4% (p > 0.05). The NMES groups achieved better lower limb muscle strength on the affected and non-affected sides results than the Control group after 12 weeks (p < 0.01). The effect size was also large(>0.89) for affected and non-affected sides MT, PA, EI and lower limb strength between the NMES group and control group measures.

Conclusion(s): The NMES groups significantly prevented of muscle atrophy and improved the muscle strength more than the control groups.
NMES is effective in the prevention of muscle atrophy and improved lower limb strength in malnutrition stroke patients.

Implications: We explained the content of the research to the participants or their families verbally and in writing and obtained written consent. This survey conforms to the ethical standards of the Declaration of Helsinki.

Funding, acknowledgements: The authors declare no conflicts of interest associated with this manuscript.

Keywords: Malnutrition stroke patients, Neuromuscular Electrical Stimulation, lower limb

Topic: Neurology: stroke

Did this work require ethics approval? Yes

Institution: Aichi Saiseikai Rehabilitation Hospital

Committee: Aichi Saiseikai Rehabilitation Hospital

Ethics number: 201908