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Y. Zheng et al.
habilitation is prescribed once the patient’s
vital signs are stable, and can significantly
improve outcomes for patients. Several stu-
Excluded (n=10)
Not meeting inclusion criteria (n=6)
dies have reported that early-phase stroke
Declined to participate (n=4)
rehabilitation may help to reduce the mor-
Other reasons (n=0)
tality and incidence of disability, improve
Randomized (n=50)
the function of the body and quality of life
and reduce medical costs (9, 17, 18).
Previously, rehabilitation for patients
Allocation
with stroke has focused mainly on training
Allocated to the CCFES group (n=25)
Allocated to the NMES group (n=25)
Received allocated intervention (n=25)
Received allocated intervention (n=25)
the proximal extremity. However, this can
Did not receive allocated intervention (n=0)
Did not receive allocated intervention (n=0)
lead to disuse of the hand and forearm,
and complications may also occur (e.g.
Follow-Up
shoulder-hand syndrome and dysmyoto-
Lost to follow-up (n=0)
Lost to follow-up (n=0)
nia). Recovery of WD and finger extension
Discontinued intervention (n=4)
Discontinued intervention (n=5)
are the most difficult aspects of hemiplegia
treatment. Moreover, WD plays an im-
Analysis
portant role in grip function and it has been
Analysed (n=21)
Analysed (n=20)
Excluded from analysis (n=0)
reported that WD deficiency is positively
Excluded from analysis (n=0)
related to dysfunction of the hand (19, 20).
Fig. 2. Study flow diagram. CCFES: contralaterally controlled functional electrical
Therefore, it is essential to involve the
stimulation; NMES: neuromuscular electrical stimulation.
patients in the rehabilitation programme.
As a conventional physical therapy,
in the NMES group, p = 0.002), active ROM of WD
NMES has been applied in stroke rehabilitation for
(mean 14.76 (SD 13.81) in the CCFES group vs 6.15
a long time. It involves low- to moderate-frequency
(SD 8.23) in the NMES group, p = 0.003), ADL score
electrical stimulation of the paretic muscles and targets
(mean 66.67 (SD 10.99) in the CCFES group vs 58.25
recovery of the function of nerve conduction, and is
(SD 11.73) in the NMES group, p = 0.023), and ICF
score (mean 13.05 (SD 3.06) in the CCFES group vs
17.10 (SD 1.12) in the NMES group, p < 0.001) between
Table III. Inter-group comparisons at baseline and endpoint
the 2 experimental groups after 2 weeks of intervention.
CCFES group NMES group
Mean (SD)
Mean (SD)
p-value
Moreover, changes between baseline and endpoint for
Structural and functional level
each parameter were significantly greater in the CCFES
FMA score of upper extremity (range 0–66)
group compared with the NMES group (Table III).
Baseline
13.19 (4.64) 14.55 (4.35)
0.340
Enrollment
Assessed for eligibility (n=60)
DISCUSSION
This randomized controlled trial (RCT) compared
the effectiveness of CCFES and NMES in patients
with early-phase stroke. Patients in the CCFES group
regained WD earlier than those in the NMES group,
and experienced better improvement in function of
the upper extremity, better ADL and general health.
Over the past decades, early-phase rehabilitation
for stroke has been developed around the world. Re-
Table II. Summary of the appearance of wrist dorsiflexion (WD)
between groups
CCFES
group
Patients with active WD, n (%)
19 (90.48)
Time interval from onset of stroke to
appearance of WD, days, mean (SD)
18.33 (7.01)
Time interval from onset of treatment to
appearance of WD, days, mean (SD)
10.48 (5.46)
NMES
group
p-value
12 (60.00)
0.025*
40.95
(20.02)
< 0.001*
31.90
(22.44)
< 0.001*
CCFES: contralaterally controlled functional electrical stimulation; NMES:
neuromuscular electrical stimulation; WD: wrist dorsiflexion; SD: standard
deviation. *: p < 0.05 indicates statistically significant.
www.medicaljournals.se/jrm
Endpoint
29.62 (6.34) 22.65 (5.67)
Change
16.38 (4.06)
8.10 (4.53)
Strength of extensor carpi (range 0–5)
Baseline
0
0
Endpoint
2.29 (0.78)
1.20 (1.06)
Change
2.29 (0.78)
1.20 (1.06)
Active ROM for WD (range 0–45°)
Baseline
0
0
Endpoint
14.76 (13.81) 6.15 (8.23)
Change
14.76 (13.81) 6.15 (8.23)
Activity level
ADL score (range 0–100)
Baseline
Endpoint
Change
JHFT (range 0–7)
Baseline
Endpoint
Change
Participation level
ICF score (range 0–10)
Baseline
Endpoint
Change
32.86 (12.90) 30.25 (10.94)
66.67 (10.99) 58.25 (11.73)
33.81 (8.05) 28.00 (5.71)
0.001*
< 0.001*
–
0.002*
0.002*
–
0.003*
0.003*
0.490
0.023*
0.011*
0.24 (0.62)
1.62 (1.32)
1.38 (1.02) 0.35 (0.59)
0.90 (0.97)
0.55 (0.60) 0.303
0.065*
0.005*
22.67 (1.80)
13.05 (3.06)
9.62 (2.11) 22.20 (1.54)
17.10 (1.12)
5.10 (1.21) 0.900
< 0.001*
< 0.001*
CCFES: contralaterally controlled functional electrical stimulation; NMES:
neuromuscular electrical stimulation; ROM: range of motion; ADL: activities of
daily living; JHFT: Jebsen Hand Function Test; ICF: International Classification
of Functioning, Disability and Health; WD: wrist dorsiflexion; SD: standard
deviation.