Efficacy of belt-type EMS in preventing ICU-acquired weakness
Table III. Outcomes of respective groups for final femoral muscle analysis. Electrical muscle stimulation (EMS) contributed to significant
inhibition rate of muscle volume loss (p = 0.0436). Barthel Index score at discharge was better in the EMS group, however, the difference
was not significant (p = 0.163). The Barthel Index score for stair-climbing (unable = 0, needs help = 5, independent up and down = 10)
was better for the EMS group than the control group (p = 0.04). Other outcomes were not different between groups. Differences were
assessed by Mann–Whitney test
Femoral muscle volume loss, %, mean (SD)
Barthel Index, mean (SD)
Transfer, mean (SD)
Mobility, mean (SD)
Stair-climbing, mean (SD)
28-day survival rate, %
ICU stay, days, mean (SD)
Hospital stay, days, mean (SD)
Mechanical ventilation, days, mean (SD)
EMS group
n = 21 Control group
n = 16 p-value
10.4 (10.1)
50.4 (31.6)
8.5 (6.5)
6.8 (9.3)
3.9 (4.0)
49.2
9.9 (5.7)
17.4 (9.9)
9.9 (6.2) 17.7 (10.8)
29.0 (18.8)
6.0 (5.5)
4.0 (5.4)
1.5 (1.5)
51.5
10.6 (4.7)
20.6 (8.9)
8.5 (4.5) 0.04*
0.16
0.36
0.32
0.04*
0.63
0.71
0.32
0.50
SD: standard deviation; ICU: intensive care unit.
Barthel Index scores were higher in the EMS group, the
difference was not statistically significant (p = 0.16).
The Barthel Index score for stair-climbing (unable= 0,
needs help= 5, independent up and down= 10) was
better for EMS group 3.9 (SD 4.0) than in the control
group 1.5 (1.5) (p = 0.04). There were no differences
in other outcomes between groups.
Basic characteristics of intention-to-treat analysis for
each group are shown in Table SI 1 . The rate of mechani-
cal ventilation was almost 80%. The 28-day survival cur-
ves (Fig. S1 1 ) were not significantly different (p = 0.79).
The other outcomes: length of ICU stay, hospital stay,
and mechanical ventilation, were also not significantly
different (Table SII 1 ). For all participants, there was no
change greater than 20% from base rate for arterial pres-
sure or heart rate, and no new arrhythmia event when the
20 min EMS or muscle loading was performed.
http://www.medicaljournals.se/jrm/content/?doi=10.2340/16501977-2594
1
4,000
3,000
day 1
2,000
day 10
1,000
*p<0,0001
0
709
EMS
Control
Fig. 3. Femoral muscle volume before and after intensive care in the
control group and electrical muscle stimulation (EMS) group. Femoral
muscle volumes: day 1 (black box) and day 10 (grey box). In both
groups, muscle volume decreased significantly from day 1 to day 10
(p < 0.0001).
DISCUSSION
This RCT study examined the efficacy of EMS on loss
of femoral muscle volume in critical care, and found
that it significantly inhibited loss of muscle volume.
The results suggest that EMS, applied via B-SES, could
be introduced to critically ill patients fduring the acute
phase of intensive care.
In this study EMS was introduced from day 2 of
ICU admission. This is regarded as the earliest intro-
duction of rehabilitation in the ICU. Early physical
rehabilitation has been reported as related to harmful
events at a rate of 5% or less (9, 11). It is regarded as
safe, although a higher incidence of harmful events
has also been reported (10). The results of one study
suggest that overly active physical rehabilitation is not
related to better outcomes (24). Therefore, caution is
warranted in introducing active physical therapy during
the acute phase. The results of the current study sug-
gest that B-SES may be considered as an alternative
physical therapy for use in early ICU rehabilitation.
Some RCTs have introduced EMS to critically
ill patients during the early phase of intensive care.
Although some reports show that EMS contributes to
a reduction in rate of loss of muscle volume (25, 26)
or maintainance of physical function (27–32), some
studies found no change in that of muscle volume (30,
32, 33, 34) or that of physical function (25, 34) with
EMS. We can speculate about the reasons for these
different results, especially with regards to muscle
volume. One explanation might be that the introduction
and evaluation time-points differed in the respective
trials. However, we consider that the most important
reason was the method of evaluating muscle volume. In
earlier studies, muscle volume outcome was evaluated
using ultrasound, by measuring the circumference of
femoral muscle or femoral muscle thickness. However,
these evaluations are affected by oedema and fat in the
muscle. Moreover, a 1- or 2-dimensional evaluation
J Rehabil Med 51, 2019