Journal of Rehabilitation Medicine 51-4inkOmslag | Page 3

J Rehabil Med 2019; 51: 237–243
REVIEW ARTICLE
EFFECTIVENESS OF NEUROMUSCULAR ELECTRICAL STIMULATION FOR
REDUCING OEDEMA: A SYSTEMATIC REVIEW
Louise C. BURGESS, BSc (Hons), Tikki IMMINS , MSc (Epid), BSc (Hons), Ian SWAIN, PhD, CEng, FIET, CSci, FIPEM
and Thomas W. WAINWRIGHT, PgDip, PgCert, BSc (Hons), MCSP
From the Orthopaedic Research Institute, Bournemouth University, 6 th Floor, Executive Business Centre, Bournemouth, UK
Objective: This systematic review aimed to assess
the clinical impact of neuromuscular electrical sti-
mulation as a treatment modality for patients with
oedema.
Data sources and study selection: PubMed was
searched up to July 2018 for randomized and non-
randomized clinical trials comparing neuromuscular
electrical stimulation vs no stimulation following the
formation of oedema. A modified Downs and Black
checklist was used to evaluate the quality of the evi-
dence.
Data synthesis: Initial searches yielded 150 results.
Removal of duplicates reduced this number to 97 re-
sults. Seventy-five studies were excluded following
a review of titles and abstracts. Full-text screening
eliminated 15 studies. A final total of 7 studies met
the inclusion criteria. Six studies supported the use
of neuromuscular electrical stimulation for oedema
reduction, and one study did not find an effect, but
reported inter-group variance.
Conclusion: The results of this systematic review
support the use of neuromuscular electrical stimula-
tion for ameliorating the abnormal accumulation of
interstitial fluid, which is clinically shown as oede-
ma. Neuromuscular electrical stimulation is effecti-
ve in a number of rehabilitation settings and patient
groups, for treatment of both upper and lower limb
oedema. However, further trials are needed to rein-
force these findings.
Key words: rehabilitation; physical therapy modalities; elec-
trical stimulation; oedema.
Accepted Jan 29, 2019; Epub ahead of print Feb 28, 2019
J Rehabil Med 2019; 51: 237–243
Correspondence address: Thomas Wainwright, Orthopaedic Research
Institute, Bournemouth University, Executive Business Centre, 89
Holdenhurst Road, Bournemouth, BH8 8EB UK. E-mail: twainwright@
bournemouth.ac.uk
O
edema may occur following a wide range of
musculoskeletal injuries and in other clinical
settings (1). Following injury an abnormal build-up
of interstitial fluid in the body can create swelling in
the affected tissue, causing pain and dysfunction (2).
Oedema may be generalized, meaning it occurs in
multiple organs across the body; however, most types
of oedema are specific to a single organ. Treatment is
individual to the type of oedema, and in some cases
the swelling resolves independently. Often, however,
LAY ABSTRACT
The aim of this review was to evaluate the effective-
ness of neuromuscular electrical stimulation for treating
oedema, which is the abnormal build up of interstitial
fluid in the body. A web-based search was performed
to evaluate clinical trials to assess the effect of neuro-
muscular stimulation within all medical populations. Six
studies were found that support the use of neuromus-
cular electrical stimulation for reducing oedema and one
study that did not. These results suggest that neuro-
muscular electrical stimulation may be useful for trea-
ting oedema in both upper and lower limbs. However,
the findings are limited and further research is needed.
the treatment of oedema following injury can be chal-
lenging. Treatment of oedema aims to correct the cause
of the fluid accumulation; however, it can be difficult
for patients to incorporate traditional management
strategies (such as rest, ice and elevation) into their
daily routines. Voluntary activation contractions can
help to improve circulation by stimulating lymphatic
flow; however, they are not always possible for a pa-
tient presenting with musculoskeletal injuries and the
use of compression devices are not always feasible for
patients with co-morbidities (3).
As well as activation of muscles via the bodies’
nervous system, muscles can also be contracted by
the application of an external electrical stimulation.
Electro-physical agents have a long-established place
in therapy practice and the emphasis of this mode of
treatment has seen significant change over time (4).
Neuromuscular electrical stimulation (NMES) is the
elicitation of an involuntary muscle contraction using
electrical impulses (5). It is proposed that the contrac-
tion of muscles causes intermittent venous compres-
sion and, because of the orientation of the venous
valves, blood is forced from the periphery, through
the veins toward the heart. The involuntary muscular
contraction lowers the mean venous pressure and ser-
ves as an auxiliary pump to assist venous return and
lymphatic flow, which may reduce oedema. Therefore,
NMES may affect the lymph drainage or the interstitial
hydrostatic pressure components of fluid exchange,
which can affect oedema formation and resolution.
Devices delivering NMES are wide ranging, and some
may cause discomfort, therefore such devices are not al-
ways utilized within a clinical setting. In addition, whilst
increased blood flow is reported to decrease oedema; the
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: 10.2340/16501977-2529