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Open Access Research article

Neuromuscular electrical stimulation for preventing skeletal-muscle weakness and wasting in critically ill patients: a systematic review

Nicola A Maffiuletti1*, Marc Roig23, Eleftherios Karatzanos4 and Serafim Nanas4

Author Affiliations

1 Neuromuscular Research Laboratory, Schulthess Clinic, Zurich, Switzerland

2 School of Physical and Occupational Therapy, McGill University, Montreal, Canada

3 Department of Exercise and Sport Sciences and Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark

4 First Critical Care Department, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece

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BMC Medicine 2013, 11:137  doi:10.1186/1741-7015-11-137

Published: 23 May 2013



Neuromuscular electrical stimulation (NMES) therapy may be useful in early musculoskeletal rehabilitation during acute critical illness. The objective of this systematic review was to evaluate the effectiveness of NMES for preventing skeletal-muscle weakness and wasting in critically ill patients, in comparison with usual care.


We searched PubMed, CENTRAL, CINAHL, Web of Science, and PEDro to identify randomized controlled trials exploring the effect of NMES in critically ill patients, which had a well-defined NMES protocol, provided outcomes related to skeletal-muscle strength and/or mass, and for which full text was available. Two independent reviewers extracted data on muscle-related outcomes (strength and mass), and participant and intervention characteristics, and assessed the methodological quality of the studies. Owing to the lack of means and standard deviations (SDs) in some studies, as well as the lack of baseline measurements in two studies, it was impossible to conduct a full meta-analysis. When means and SDs were provided, the effect sizes of individual outcomes were calculated, and otherwise, a qualitative analysis was performed.


The search yielded 8 eligible studies involving 172 patients. The methodological quality of the studies was moderate to high. Five studies reported an increase in strength or better preservation of strength with NMES, with one study having a large effect size. Two studies found better preservation of muscle mass with NMES, with small to moderate effect sizes, while no significant benefits were found in two other studies.


NMES added to usual care proved to be more effective than usual care alone for preventing skeletal-muscle weakness in critically ill patients. However, there is inconclusive evidence for its benefit in prevention of muscle wasting.

Muscle strength; Muscle mass; Quadriceps femoris; Intensive care; Sepsis; Rehabilitation