Effects of neuromuscular electrical stimulation (NMES) in patients undergoing haemodialysis: a systematic review and meta-analysis.

Background

Neuromuscular electrical stimulation (NMES) uses surface electrodes to deliver electrical impulses that stimulate motor nerves causing muscle contractions. A potential use of NMES is for intradialytic rehabilitation strategy for patients undergoing maintenance haemodialysis (HD), but its effectiveness remains uncertain. This review analysis and meta-analysis evaluated whether the effects of NMES improve outcomes on physical performance, muscle strength, biochemical markers and Quality of Life (QoL) in patients undergoing long-term haemodialysis.

Methods

This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. Randomised controlled trials (RCTs) were selected on PubMed, Scopus, Web of Science and Embase. Selected eligible studies were analysed for Quality of Life, functional capacity and physical performance, muscle strength, biochemical parameters and adverse effects. Results were expressed as mean differences (MD) or standardised mean differences (SMD) with a 95% confidence interval.

Results

11 RCTs met the inclusion criteria, involving a total of 346 patients from 7 countries on long-term HD. NMES was associated with a significantly increased handgrip strength (pooled MD = 3.34 kg, 95% CI 0.95-5.73, P = 0.006); however, statistical significance was lost when one contributing trial was excluded in the leave-one-out analysis. There were no statistically significant benefits in pooled analysis of broader measures of physical performance including the six-minute walk test or sit-to-stand test, nor in biochemical markers or other SF-36 domains including mental health, vitality and social functioning.

Conclusion

NMES may offer selective benefits in patients undergoing long-term haemodialysis such as improved handgrip strength; however, this was based on two small trials and was sensitive to the exclusion of one contributing study. No consistent benefits were observed across broader functional, biochemical or patient-reported outcomes. NMES may therefore represent a potential adjunct, but current evidence is insufficient to support replacing conventional intradialytic rehabilitation.