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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Benefits of FES gait in a spinal cord injured population

EJ Nightingale, J Raymond, JW Middleton, J Crosbie, and GM Davis.

Review published: 2007.

CRD summary

The authors concluded that functional electrical stimulation gait training benefited walking ability in people with incomplete spinal cord injuries; there was insufficient research regarding secondary outcomes. This was a poorly-reported review and the evidence base and synthesis were considerably limited. Therefore, definitive conclusions could not be drawn from the evidence and the authors’ conclusions should not be considered reliable.

Authors' objectives

To assess the effects of functional electrical stimulation-assisted gait in patients with spinal cord injury.

Searching

MEDLINE and Science Direct were searched up to December 2006 for publications in English; search terms were reported. In addition, journals and conference proceedings (not specified) were manually searched.

Study selection

Eligible for inclusion were studies that assessed the effects of functional electrical stimulation-assisted gait training in patients with spinal cord injury. Eligible studies had to report objective/quantifiable measures on clinical, fitness-related, or functional outcomes (as defined in the review) at baseline and follow up. Abstracts with incomplete information were excluded from the review, as were studies using subjective outcome assessment methods.

Included studies were published from 1984 to 2006. Participant details were lacking. The type and frequency of intervention varied between studies. Various methods were used to measure the different outcomes. Some studies compared functional electrical stimulation-assisted gait versus orthosis-supported gait.

The authors did not state how many reviewers screened studies for inclusion.

Assessment of study quality

The authors did not state that they formally assessed study quality, but did mention study design details.

Data extraction

Data were extracted at baseline and follow-up to assess changes in outcomes.

The authors did not state how many reviewers performed the data extraction.

Methods of synthesis

Due to differences between the studies, a narrative synthesis was presented by outcome (clinical, cardiorespiratory fitness, and functional) or to compare the functionality of functional electrical stimulation-assisted gait versus orthosis-supported gait.

Results of the review

Thirty-six studies were included in the review. Most studies appeared to be pre-/post-intervention studies. Where follow-up durations were reported, this appeared to range up to 12 months in most studies.

Clinical outcomes: Two of three studies reported a decrease in muscle spasms following intervention in participants with incomplete spinal cord injury. Eight studies assessed lower limb muscle strength; all showed increased muscle strength and/or muscle girth following intervention.

Two studies that assessed bone mineral density showed no differences following intervention. Findings from single studies were reported in the review.

Cardiorespiratory fitness outcomes: The findings from two studies were contradictory.

Functional outcomes: Most of the 11 studies that assessed gait parameters showed improvements following intervention, but statistical significance was not always demonstrated. The effects of intervention on joint kinematics and energy cost of gait were mixed (as reported in the review).

There were no significant differences in outcomes when comparing functional electrical stimulation versus orthoses. Other findings were reported in the review.

Authors' conclusions

Functional electrical stimulation gait training offered benefits in walking ability in people with incomplete spinal cord injuries. There was insufficient research to draw conclusions on secondary outcomes of functional stimulation gait training.

CRD commentary

The review question was broadly defined. The literature search was limited and restricted by language, which meant that potentially relevant data may have been missed. The authors did not state whether each stage of the review process was performed in duplicate, which meant that reviewer error and bias could not be ruled out.

Study quality was not formally assessed, but the authors did acknowledge that none were randomised controlled trial, most lacked comparison groups, and many were single case studies. The authors acknowledged that there was some overlap in study populations. The total number of included participants was unclear, but most studies appeared to include less than 15 patients. Study details were presented for 34 studies, so details on the remaining two studies were unknown. Given the differences between studies in type of intervention, intervention frequency, and outcome assessments, a narrative synthesis seemed appropriate. However, this was limited as the significance of the findings was generally unknown.

This was a poorly-reported review that was at risk of various forms of bias. The evidence base and synthesis were considerably limited, which suggested that definitive conclusions could not be drawn, therefore the authors’ conclusions cannot be considered reliable.

Implications of the review for practice and research

Practice: The authors stated that there was insufficient evidence to make claims in people with complete spinal cord injuries.

Research: The authors stated that further good quality, randomised controlled trials were required to assess the efficacy of functional electrical stimulation gait training that may be related to clinical consequences following spinal cord injury.

Funding

Not stated.

Bibliographic details

Nightingale EJ, Raymond J, Middleton JW, Crosbie J, Davis GM. Benefits of FES gait in a spinal cord injured population. Spinal Cord 2007; 45(10): 646-657. [PubMed: 17646840]

Indexing Status

Subject indexing assigned by NLM

MeSH

Bone Density; Electric Stimulation Therapy; Gait; Humans; Muscle Strength /physiology; Muscle, Skeletal /physiology; Physical Fitness; Spinal Cord Injuries /rehabilitation; Treatment Outcome

AccessionNumber

12007003467

Database entry date

04/11/2013

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.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 17646840

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