CRD summary

This review examined the effectiveness of electromyogram-triggered neuromuscular stimulation on hand and arm function in stroke patients. The authors concluded that this treatment is effective. However, since some trials were non-randomised and the review included only a small number of patients, it is unclear how reliable the authors' conclusions are.

Authors' objectives

To assess the effectiveness of electromyogram (EMG)-triggered neuromuscular stimulation on hand and arm function in stroke patients.

Searching

MEDLINE (1979 to 2003), the Cochrane Database of Systematic Reviews (Issue 3, 2003) and the Cochrane Controlled Trials Register (Issue 3, 2003) were searched; some search terms were given. In addition, relevant bibliographies published between 1973 and 2003 were handsearched. Only studies published in English in peer-reviewed journals were included.

Study selection

Assessment of study quality

The quality of studies included in the meta-analysis was assessed on the basis of randomisation, double-blinding, and the assessment of withdrawals and drop-outs. The authors did not state how the papers were assessed for quality, or how many reviewers performed the quality assessment.

Data extraction

The authors did not state how the data were extracted for the review, or how many reviewers performed the data extraction.

Methods of synthesis

Results of the review

Seven studies were included in the review, five of which were included in a meta-analysis. Three of the studies were RCTs. It was not possible to determine the total number of patients in the review, but the five studies included in the meta-analysis contained 86 patients.

No statistically significant heterogeneity between the studies was found (chi-squared 1.15, P>0.05).

For standardised and representative response measure for hand arm function, the pooled effect size was 0.82 (95% confidence interval, CI: 0.10, 1.55).

A fail-safe analysis indicated that 15 null effect studies would be required to reduce the effect size from 0.82 (high) to 2.0 (low).

Authors' conclusions

EMG-triggered neuromuscular stimulation is an effective post-stroke therapy.

CRD commentary

The review question was clear but the inclusion criteria were not specified in full. The authors searched relevant electronic databases but they excluded unpublished studies, studies published in non-peer-reviewed journals and studies published in languages other than English. This might have increased the possibility of publication bias or language bias in the review, both of which can lead to the exclusion of studies that are more likely to have negative findings. The authors assessed the methodological quality of the included studies, but they did not report using methods to minimise bias and error in this assessment or in the study selection and data extraction processes of the review. The use of a meta-analysis to combine the studies appeared justifiable. The results of the quality assessment were not used to inform sensitivity analyses, although non-randomised studies were included. The included studies were all small and two of those included in the meta-analysis were non-randomised. As a consequence of these considerations and the fact that the review methodology was not well reported, it is not possible to say whether the authors' conclusions are reliable.

Implications of the review for practice and research

Practice: The authors stated that stroke rehabilitation therapists should employ informed judgement in using their findings to make effective improvements in arm and hand motor rehabilitation.

Research: The authors did not state any implications for further research.

Bibliographic details

Bolton D A, Cauraugh J H, Hausenblas H A. Electromyogram-triggered neuromuscular stimulation and stroke motor recovery of arm/hand functions: a meta-analysis. Journal of the Neurological Sciences 2004; 223(2): 121-127. [PubMed: 15337612]

Indexing Status

Subject indexing assigned by NLM

MeSH

Arm /physiopathology /radiation effects; Double-Blind Method; Electric Stimulation; Electromyography /methods; Hand /physiopathology /radiation effects; Humans; Motor Activity /physiology /radiation effects; Neuromuscular Junction /physiopathology /radiation effects; PubMed /statistics & numerical data; Randomized Controlled Trials as Topic /methods; Recovery of Function /physiology /radiation effects; Stroke /physiopathology /rehabilitation; Treatment Outcome

AccessionNumber

12004006590

Database entry date

31/07/2006

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.