Effectiveness of neuromuscular electrical stimulation in patients with acute exacerbation of chronic obstructive pulmonary disease: A systematic review and meta-analysis

Background and Purpose: This study aimed to investigate the effectiveness and acceptability of neuromuscular electrical stimulation (NMES) in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods: We conducted a systematic review and meta-analysis to investigate the effectiveness and accessibility of NMES and compared them with usual care in patients with acute exacerbation of COPD by searching databases such as MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials published up to April 2022. Randomized controlled trials (RCTs) involving patients with COPD who were treated within 3 weeks of acute exacerbation onset were included. The risk of bias was assessed using the RoB 2 tools. We pooled limb muscle strength and adverse events and performed a comparison between NMES and usual care. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Results: Five RCTs, including 168 patients, met the eligibility criteria. The meta-analysis showed that limb muscle strength was significantly higher in the NMES group (four studies with 148 patients; standardized mean difference, 0.95; 95% confidence interval, 0.60-1.30; p < 0.001). The quality of evidence was very low due to the risk of bias within the studies, imprecision of the estimates, and small number of studies. Any adverse events served as outcomes in three studies (86 patients), although no adverse events occurred. Conclusion: NMES is safe for patients with acute exacerbation of COPD and may maintain and improve limb muscle strength; however, the quality of evidence was very low.