Effect of Neuromuscular Electrical Stimulation on Muscle Atrophy in Patients with Acute Stroke: A Randomized Controlled Trial.

Objectives: This study aimed to assess the effectiveness of neuromuscular electrical stimulation (NMES) in reducing muscle atrophy in patients with acute stroke. Methods: In acute stroke patients with hemiparesis, NMES or control treatment was applied to the quadriceps muscles for 2 weeks. The change of the quadriceps muscle thickness was assessed using ultrasound after 2 weeks. Results: Sixty-three patients were randomized to control treatment or NMES treatment. On the paretic side, muscle thickness changed by -2.65 ± 4.24 mm in the NMES group and -4.64 ± 4.58 mm in the control group (P=0.119). On the non-paretic side, the respective changes were -0.42 ± 5.19 mm and -1.93 ± 3.36 mm (P=0.223). In an exploratory subgroup analysis, no significant effect was observed in severely affected patients, whereas patients with mild-to-moderate stroke (National Institute of Health Stroke Scale score <12, n=23) showed a smaller reduction in quadriceps thickness on the paretic side in the NMES group compared with controls (0.00 ± 3.21 mm vs. -3.88 ± 5.11 mm, P=0.043). These exploratory subgroup findings should be regarded as hypothesis-generating. Conclusions: This underpowered trial did not demonstrate a significant preventive effect of 2 weeks of NMES on quadriceps atrophy in patients with acute stroke. Exploratory subgroup findings suggest a potential benefit in patients with less severe stroke, but these results should be considered hypothesis-generating and require confirmation in future adequately powered trials.