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Standard early rehabilitation and lower limb transcutaneous nerve or neuromuscular electrical stimulation in acute stroke patients: a randomized controlled pilot study [with consumer summary]
Yen H-C, Chen W-S, Jeng J-S, Luh J-J, Lee Y-Y, Pan G-S
Clinical Rehabilitation 2019 Aug;33(8):1344-1354
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: We investigated adding lower limb transcutaneous nerve stimulation or neuromuscular electrical stimulation to standard early rehabilitation in acute stroke patients. DESIGN: An assessor-blinded, randomized controlled pilot study. SETTING: A medical stroke center. SUBJECTS: First-stroke patients aged 20 to 80 years admitted to the stroke center within 24 hours post stroke. INTERVENTIONS: A total of 42 participants were randomly assigned to groups: transcutaneous nerve stimulation plus standard early rehabilitation, neuromuscular electrical stimulation plus standard early rehabilitation, or standard early rehabilitation-only. Transcutaneous nerve or neuromuscular electrical stimulation was delivered to the affected tibialis anterior and quadriceps muscles for 30 minutes a day, five days per week for two weeks. MAIN MEASURES: The Postural Assessment Scale for Stroke Patients, the Functional Independence Measure, and three mobility milestones, namely, sitting for > five minutes, standing for > one minute, and walking >= 50 m, were evaluated, respectively, at baseline, at the two-week post-intervention, and at two-week follow-up. RESULTS: Significant differences existed in the Postural Assessment Scale for Stroke Patients scores between the transcutaneous nerve stimulation and standard early rehabilitation-only groups measured at two-weeks post-intervention (mean (SD) 31.38 (5.39) and 18.00 (8.65), respectively) and at the two-week follow-up (34.08 (2.69) and 26.14 (7.77), respectively). A higher proportion of participants could walk >= 50 m independently in the transcutaneous nerve stimulation group than in the standard early rehabilitation-only group at the two-week post-intervention (p = 0.013) and two-week follow-up (p = 0.01) marks. CONCLUSION: Two weeks of transcutaneous nerve stimulation added to standard early rehabilitation improved postural stability and walking in acute stroke patients.

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