title: A randomized controlled trial of surface neuromuscular electrical stimulation applied early after acute stroke: effects on wrist pain, spasticity and contractures.
abstract: OBJECTIVE
  To investigate effects of surface neuromuscular electrical stimulation applied early after stroke to the wrist and finger extensor muscles on upper limb pain, spasticity and contractures in patients with no functional arm movement.
  
  
  METHODS
  Secondary analysis from a Phase II, randomized, controlled, single-blind study.
  
  
  METHODS
  An acute hospital stroke unit.
  
  
  METHODS
  Patients with no useful arm function within six weeks of a first stroke.
  
  
  METHODS
  Patients were randomized to treatment (30-minute sessions of surface neuromuscular stimulation to wrist and finger extensors and 45 minutes of physiotherapy) or control (45 minutes of physiotherapy) groups. All patients had access to routine care. Treatment was given for six weeks from recruitment.
  
  
  RESULTS
  Ninety patients (49% male, median age 74 years (range 32-98), median time since stroke onset three weeks (range one to six weeks)) were included. Treatment compliance was variable (mean 28%). The treatment prevented the development of pain (mean difference in rate of change 0.4 units/week, 95% confidence interval (CI) 0.09 to 0.6). Treatment may have prevented a deterioration in contractures (quantified by measuring passive range of movement) in severely disabled patients (mean rate of deterioration -0.5 deg/week; 95% CI -0.9 to -0.06). There were no significant changes in stiffness and spasticity.
  
  
  CONCLUSIONS
  Surface neuromuscular electrical stimulation reduces pain in stroke patients with a non-functional arm. There was some evidence that treatment with electrical stimulation was beneficial in reducing contractures. Treatment had no effect on spasticity.
authors.affiliation: School of Health and Rehabilitation, Keele University, UK.
authors.forename: Shweta
authors.initials: S
authors.lastname: Malhotra
authors.forename: Sheeba
authors.initials: S
authors.lastname: Rosewilliam
authors.forename: Hermie
authors.initials: H
authors.lastname: Hermens
authors.forename: Christine
authors.initials: C
authors.lastname: Roffe
authors.forename: Peter
authors.initials: P
authors.lastname: Jones
authors.forename: Anand David
authors.initials: AD
authors.lastname: Pandyan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003286:Contracture / Q000209:etiology / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D005384:Finger Joint / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000209:etiology / Q000628:therapy*; D018482:Muscle, Skeletal / Q000503:physiopathology; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D059408:Pain Management / Q000379:methods*; D020127:Recovery of Function; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D061665:Time-to-Treatment; D014955:Wrist Joint / Q000503:physiopathology
keywords: Stroke; contractures; neuromuscular electric stimulation; pain; spasticity