title: Effects of Electrical Stimulation in Spastic Muscles After Stroke: Systematic Review and Meta-Analysis of Randomized Controlled Trials.
abstract: OBJECTIVE
  Neuromuscular electric stimulation (NMES) has been used to reduce spasticity and improve range of motion in patients with stroke. However, contradictory results have been reported by clinical trials. A systematic review of randomized clinical trials was conducted to assess the effect of treatment with NMES with or without association to another therapy on spastic muscles after stroke compared with placebo or another intervention.
  
  
  METHODS
  We searched the following electronic databases (from inception to February 2015): Medline (PubMed), EMBASE, Cochrane Central Register of Controlled Trials and Physiotherapy Evidence Database (PEDro). Two independent reviewers assessed the eligibility of studies based on predefined inclusion criteria (application of electric stimulation on the lower or upper extremities, regardless of NMES dosage, and comparison with a control group which was not exposed to electric stimulation), excluding studies with <3 days of intervention. The primary outcome extracted was spasticity, assessed by the Modified Ashworth Scale, and the secondary outcome extracted was range of motion, assessed by Goniometer.
  
  
  RESULTS
  Of the total of 5066 titles, 29 randomized clinical trials were included with 940 subjects. NMES provided reductions in spasticity (-0.30 [95% confidence interval, -0.58 to -0.03], n=14 randomized clinical trials) and increase in range of motion when compared with control group (2.87 [95% confidence interval, 1.18-4.56], n=13 randomized clinical trials) after stroke.
  
  
  CONCLUSIONS
  NMES combined with other intervention modalities can be considered as a treatment option that provides improvements in spasticity and range of motion in patients after stroke.
  
  
  BACKGROUND
  URL: http://www.crd.york.ac.uk/PROSPERO. Unique identifier: CRD42014008946.
authors.affiliation: From the Physical Therapy Department, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil (C.S., C.G.F., C.R., R.D.M.P.); Laboratory of Clinical Investigation, Instituto de Cardiologia do Rio Grande do Sul (IC), Fundação Universidade de Cardiologia (FUC), Porto Alegre, RS, Brazil (C.S.); and Physical Therapy Undergraduation, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil (G.S.).
authors.forename: Cinara
authors.initials: C
authors.lastname: Stein
authors.affiliation: From the Physical Therapy Department, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil (C.S., C.G.F., C.R., R.D.M.P.); Laboratory of Clinical Investigation, Instituto de Cardiologia do Rio Grande do Sul (IC), Fundação Universidade de Cardiologia (FUC), Porto Alegre, RS, Brazil (C.S.); and Physical Therapy Undergraduation, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil (G.S.).
authors.forename: Carolina Gassen
authors.initials: CG
authors.lastname: Fritsch
authors.affiliation: From the Physical Therapy Department, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil (C.S., C.G.F., C.R., R.D.M.P.); Laboratory of Clinical Investigation, Instituto de Cardiologia do Rio Grande do Sul (IC), Fundação Universidade de Cardiologia (FUC), Porto Alegre, RS, Brazil (C.S.); and Physical Therapy Undergraduation, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil (G.S.).
authors.forename: Caroline
authors.initials: C
authors.lastname: Robinson
authors.affiliation: From the Physical Therapy Department, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil (C.S., C.G.F., C.R., R.D.M.P.); Laboratory of Clinical Investigation, Instituto de Cardiologia do Rio Grande do Sul (IC), Fundação Universidade de Cardiologia (FUC), Porto Alegre, RS, Brazil (C.S.); and Physical Therapy Undergraduation, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil (G.S.).
authors.forename: Graciele
authors.initials: G
authors.lastname: Sbruzzi
authors.affiliation: From the Physical Therapy Department, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil (C.S., C.G.F., C.R., R.D.M.P.); Laboratory of Clinical Investigation, Instituto de Cardiologia do Rio Grande do Sul (IC), Fundação Universidade de Cardiologia (FUC), Porto Alegre, RS, Brazil (C.S.); and Physical Therapy Undergraduation, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil (G.S.). roplentz@yahoo.com.br rodrigop@ufcspa.edu.br.
authors.forename: Rodrigo Della Méa
authors.initials: RD
authors.lastname: Plentz
mesh_terms: D004599:Electric Stimulation Therapy / Q000379:methods* / Q000639:trends; D006801:Humans; D009128:Muscle Spasticity / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D016059:Range of Motion, Articular / Q000502:physiology; D020521:Stroke / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
keywords: electric stimulation; muscle spasticity; review; stroke