Application of neuromuscular electrical stimulation during immobilization of extremities for musculoskeletal conditions: A scoping review
Bibliographic record
Abstract
BACKGROUND: Neuromuscular electrical stimulation (NMES) is effective at improving recovery after periods of disuse. It is unclear if NMES can be applied during periods of immobilization for musculoskeletal conditions to mitigate resulting impairments from disuse. The aim of this scoping review is to describe the state of the literature applying NMES during immobilization to treat upper and lower extremity musculoskeletal conditions. METHODS: A literature search was conducted in October 2023 combining keywords related to "neuromuscular electrical stimulation", "musculoskeletal", and "immobilization" in Pubmed, Scopus, CINAHL, and Proquest Dissertations and Thesis with an English filter. Articles were included if an upper or lower extremity was immobilized during the NMES application and NMES was applied with surface electrodes. Articles were excluded if NMES was applied outside of the immobilization period, participants had a neurological condition that could impair neuromotor pathways, and/or electrical stimulation was applied invasively. Data extracted included study design, sample characteristics, immobilization protocol, intervention, stimulation parameters, outcome measures, and results. The Joanna Briggs Institute (JBI) Critical Appraisal Tools for Cohort Studies was used to assess quality for all included studies. RESULTS: Six studies with 127 participants were included. The musculoskeletal conditions addressed were anterior cruciate ligament repair and tibia fracture. Immobilization procedures maintain knee flexion between 10 and 45° for four to six weeks. NMES was applied through holes cut in the casts. NMES duration ranged from 40 minutes to 8 hours a day with an alternating current ramping up over 0.4 to 4 seconds (s), the contraction duration between two and 20 s, and rest times between five and 50 s. NMES application improved quadriceps atrophy and strength outcomes in four studies. DISCUSSION: The body of literature is limited to two patient populations, only a small sample of cohort studies, physiological outcomes, and all studies were published before 1989. The models used in these studies are outdated, so new models (i.e. distal radius fracture) are proposed to investigate NMES application during immobilization in musculoskeletal populations. This study highlights a substantial gap in the literature and that further investigation into NMES application during immobilization for musculoskeletal conditions is warranted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.036 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.005 |
| Bibliometrics | 0.013 | 0.014 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".