Journal of Rehabilitation Medicine 51-9 | Page 81

J Rehabil Med 2019; 51: 705–711 ORIGINAL REPORT EFFICACY OF BELT ELECTRODE SKELETAL MUSCLE ELECTRICAL STIMULATION ON REDUCING THE RATE OF MUSCLE VOLUME LOSS IN CRITICALLY ILL PATIENTS: A RANDOMIZED CONTROLLED TRIAL Kensuke NAKAMURA, MD, PhD 1 , Atsushi KIHATA, RT 1 , Hiromu NARABA, MD 1 , Naoki KANDA, MD 1 , Yuji TAKAHASHI, MD 1 , Tomohiro SONOO, MD 1 , Hideki HASHIMOTO, MD 1 and Naoto MORIMURA, MD, PhD 2 From the 1 Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Ibaraki and 2 Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan Objectives: Belt electrode skeletal muscle electri- cal stimulation can induce muscle contraction of the whole lower body. This study examined the efficacy of belt electrode skeletal muscle electrical stimula- tion on reducing loss of muscle volume in critically ill patients. Methods: Intensive care unit patients were random- ly assigned to control and electrical muscle stimula- tion groups. In both groups, early rehabilitation was administered from day 2 of admission. In the electri- cal muscle stimulation group, belt electrode skeletal muscle electrical stimulation was administered. Fe- moral muscle volume was evaluated with computed tomography on days 1 and 10. Results: Ninety-Four severely ill patients were inclu- ded 47 patients were assigned to each group. Femo- ral muscle volumes of 16 control and 21 electrical muscle stimulation group patients were measured. For both groups, femoral muscle volume decreased significantly from day 1 to day 10 (p < 0.0001). The mean rate of muscle volume loss was 17.7% (stan- dard deviation (SD) 10.8%) for the control group and 10.4% (SD 10.1%) for the electrical muscle sti- mulation group (p = 0.04). The score for stair-clim- bing of Barthel Index was significantly better in the electrical muscle stimulation group 3.9 (SD 4.0) than in the control group 1.5 (1.5) (p = 0.04). Conclusion: Belt electrode skeletal muscle electrical stimulation has the potential to inhibit muscle vo- lume loss in critical care. Key words: electrical muscle stimulation; critical care; inten- sive care unit acquired weakness; muscle volume; rehabilita- tion. Accepted Aug 14, 2019; Epub ahead of print Aug 30, 2019 J Rehabil Med 2019; 51: 705–711 Correspondence address: Kensuke Nakamura, Department of Emer- gency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi, Ibaraki, 317-0077, Japan. E-mail: mamashockpa- [email protected] P hysical deterioration and muscle weakness among patients in the intensive care unit (ICU), caused by immobilization and by various illness and inflamma- tion, are collectively termed intensive care unit acquired weakness (ICU-AW) (1, 2). Early rehabilitation can improve activities of daily living (ADL), exercise func­ LAY ABSTRACT Belt electrode skeletal muscle electrical stimulation can induce muscle contraction of the whole lower body. We examined its efficacy in intensive care. We randomly as- signed intensive care unit patients to control and elec- trical muscle stimulation groups. Early rehabilitation was administered from day 2 and electrical muscle stimula- tion was administered by belt electrode skeletal muscle electrical stimulation. Femoral muscle volume was eva- luated using computed tomography. Ninety-four severely ill patients were included and assigned to 47 control and 47 electrical muscle stimulation groups. Femoral muscle volumes were decreased significantly during day 1 to day 10 in both group, however, electrical muscle stimulation significantly inhibited muscle volume loss. There was a trend to improve the activity of daily living at discharge for electrical muscle stimulation. Belt electrode skeletal muscle electrical stimulation can be introduced from the acute phase of intensive care and inhibit muscle volume loss in critically ill patients. tion, length of hospital stay, and mechanical ventilation (3–6). However, there are no publications regarding its effect on ICU-AW (7). It is often difficult to provide adequate physical therapy to critically ill patients due to disturbance of consciousness or the use of sedative agents (8). Although early rehabilitation in the ICU is regarded as a safe intervention (9–11), the safety of active physical therapy requires further research. Electrical muscle stimulation (EMS) is used in phy- sical therapy to induce muscle contraction via nerves using the application of electrical pulses below the pain threshold. EMS can be applied to patients with disturbance of consciousness (12, 13), therefore its use in critically ill patients is anticipated; and some reports have described its efficacy (14–16). A popular type of EMS is the pad type, which induces muscle contractions between pads. Belt-electrode skeletal muscle electrical stimulation (B-SES) is a belt-type EMS that induces contraction of wide and multiple muscles between belts, and which can be used to pro- vide exercise to the entire lower body (17, 18). There are no study publications regarding the use of B-SES for critically ill patients, although it may be effective for use in physical therapy in the ICU. This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2594