title: An evaluation of neuromuscular electrical stimulation in critical care using the ICF framework: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To review, in conformance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the totality of evidence for the use of neuromuscular electrical stimulation (NMES) in the critical care setting, when compared with usual care, under all domains of the World Health Organisation, International Classification of Functioning, Disability and Health (ICF) framework.
  
  
  METHODS
  Six electronic databases were searched: PubMed, Embase, Web of Knowledge, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library and the Physiotherapy Evidence Database (PEDro) (1945-2014). Limits of the English language and human studies were applied.
  
  
  METHODS
  Trials investigating the effect of NMES in critical care adult patients were included. One reviewer excluded articles by title. Two reviewers excluded remaining articles by abstract and full text. One reviewer extracted data under a standardised form. Two reviewers assessed methodological quality using the Cochrane Risk of Bias Tool and the Newcastle Ottawa Scale.
  
  
  RESULTS
  Twelve full-text articles, eleven randomised controlled trials (RCTs) and one case-control trial indicated the potential of NMES to preserve muscle mass and joint range of motion, improve outcomes of ventilation, and reduce activity limitations. Meta-analysis from three RCTs supported NMES to preserve muscle strength using a fixed-effects model [n = 146; standardised mean difference 0.93 (0.51, 1.35) P = 0.0002]; however, significant heterogeneity was recorded. No outcomes evaluated the effect on participation restrictions.
  
  
  CONCLUSIONS
  NMES, as an adjunct to current rehabilitation practices in critically ill patients, may maintain muscle strength. However, high-quality studies with longer follow-up periods and standardised outcome measures across all domains of the ICF framework are required.
authors.affiliation: UCD School of Public Health, Physiotherapy and Population Science, Health Sciences Centre, University College Dublin, Dublin, Ireland.
authors.forename: Dearbhla
authors.initials: D
authors.lastname: Burke
authors.affiliation: Physiotherapy Department, Mater Misericordia Hospital, Dublin, Ireland.
authors.forename: Emma
authors.initials: E
authors.lastname: Gorman
authors.affiliation: College of Health Sciences, Health Sciences Centre Library, University College Dublin, Dublin, Ireland.
authors.forename: Diarmaid
authors.initials: D
authors.lastname: Stokes
authors.affiliation: UCD School of Public Health, Physiotherapy and Population Science, Health Sciences Centre, University College Dublin, Dublin, Ireland.
authors.forename: Olive
authors.initials: O
authors.lastname: Lennon
mesh_terms: D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D004599:Electric Stimulation Therapy / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D018908:Muscle Weakness / Q000534:rehabilitation* / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
keywords: artificial respiration; critical care; electric stimulation therapy; intensive care; rehabilitation