Journal of Rehabilitation Medicine 51-9 | Page 85

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