Category: Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development); Neuroplasticity (includes neuroscience); Technology (e.g. robotics, assistive technology, mHealth)
Objective(s) : To create succinct, evidence-based clinical practice guidelines regarding the use of Functional Electrical Stimulation (FES) to remediate gait deficits in individuals with Multiple Sclerosis (MS).
Data Sources : A systematic review was performed using the following search terms: “multiple sclerosis” AND “functional electrical stimulation” AND (“systematic review" OR "meta-analysis").
Study Selection : Three systematic reviews/meta-analyses were identified,(1-3) collectively drawing from CIHAHL, Embase, Cochrane Library, MEDLINE, PubMed, PEDRO and ProQuest. These publications reported upon an average of 13 trials (range, 8-19), inclusive of an average of 352 patients (range, 162-447). Methodologic quality assessments were performed using the Downs and Black checklist and the Effective Public Health Practice Project tool.
Data Extraction : Explicit evidence statements and well-supported narrative statements were extracted from the identified source publications. Several statements were considered within the domains of comparative efficacy (FES vs no intervention). Potential benefits included enhanced gait velocity, energetic efficiencies, gait kinematics and quality of life. Limitations included inconsistent responsiveness to FES, a general lack of therapeutic effects and limited benefits in longer walking tests.
Data Synthesis : The following recommendations were synthesized from the extracted evidence statements:
Recommendation 1: FES is not suitable for all patients with multiple sclerosis.
Recommendation 2: Assuming correct patient selection, FES is indicated to increase both the initial and ongoing walking speeds during active use.
Recommendation 3: FES is unlikely to provide therapeutic benefits (ie, when FES is not actively in use) to walking speed in patients with multiple sclerosis
Recommendation 4: Assuming correct patient selection, FES is associated with significant positive effects on different aspects of health related quality of life.
Conclusions : Patient selection is a critical factor in ensuring several known FES benefits for persons with MS.
Phillip Stevens
– Director, Department of Clinical and Scientific Affairs, Hanger Clinic, Salt Lake City, Utah