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L. C. Burgess et al
it is difficult to compare methodologies from such a
variety of clinical rehabilitation settings. Increasing
the number of well-conducted, adequately powered
RCTs with a standardized methodology would enable
practitioners to confidently prescribe NMES as a mo-
dality for decreasing oedema.
In addition, within the study results, there is a wide
variation within the equipment used to deliver NMES
to patients. Therefore, it is not easy to advocate the
use of one NMES device over the other, as there are
not enough published studies to allow comparative
analysis. The majority of studies utilized NMES de-
vices that were applied to the skin surface; however,
2 studies utilized foot-plate NMES (Revitive XI) (12,
13), which is another methodological variance that
prevents generality of results. The Revitive IX device
has a rocker device that elicits active and repetitive
plantar flexion and dorsiflexion and so whether the ef-
fect is due to limb movement or purely NMES cannot
be defined. Active plantar flexion and dorsiflexion are
rehabilitative exercises prescribed to increase lower
limb blood flow. Thus, reduction in oedema following
treatment with the Revitive XI device may be attribu-
table to the NMES, the active mobility exercises or a
combination of both treatments. This has relevance to
clinical populations where movement is prohibited.
In order to draw a clinically significant conclusion,
it is important that studies are appropriately powered
(19). Out of the 7 studies sourced, 2 had fewer than
12 study participants (13, 17). Although these small
studies present meaningful results and can assess
feasibility, their clinical importance is compromised
due to their underpowered methodologies. Across all
clinical settings, there is a lack of adequately powered
RCTs investigating the effect of NMES for oedema.
Conclusion
Six studies demonstrated that NMES devices are effec-
tive in the treatment or management of oedema, with
no reported adverse events. There is some evidence,
Table IV. Percentage change in oedema
Study
Device
Oedema
change
Percentage
change
Percentage decrease in oedema size (displacement or circumference)
Bogachev et al. (11)
Veinoplus
–20.3 mm
–7.3
Devrimsel et al. (16)
Cefar
–16.6 ml
–49.4
Faghri (17)
Medtronic
Arm: –32.6 ml/ –2.64/
Hand: –13.4 ml –0.53
Man et al. (15)
HEALTHFIT –8 ± 65 ml
–0.5
Wou et al. (13)
Geko
40.6 ml*
–0.06*
–0.22*
Revititive IX 30.7 ml*
Prevention studies (percentage increase in oedema)
Man et al. (14)
HEALTHFIT 12 ± 39 ml
Ravikumar et al. (12)
Revitive IX 176 ml
*Percentage change relevant to control group.
www.medicaljournals.se/jrm
0.8
3.4
outlined above, to the effect that NMES activation of
the venous pumps in the extremities is effective in
reducing oedema in those extremities, in a variety of
different patient groups. One study did not find a sig-
nificant clinical effect of NMES in reducing oedema;
however, the authors recognize that this result may be
confounded by inter-group variance (15). Appropria-
tely powered clinical trials are required with oedema
as a primary outcome and a focus on returning to
function and recovery. Future studies should also aim
to establish the most effective mode of delivery and
dose for NMES to facilitate recovery from different
diseases, procedures or anatomical locations.
ACKNOWLEDGEMENT
Thomas Wainwright reports personal non-related consultancy
fees from ZimmerBiomet, Sky Medical Technology, The Tech-
nology Partnership, Medacta, and Medtronic. He is a Director and
Shareholder in Healthdecoded Ltd. He has received institutional
research grants from Dorset Local Enterprise Partnership, Wessex
Academic Health Science Network, OSSIM Technologies, and
The Technology Partnership outside the submitted work.
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