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Does using electrical stimulation (i.e. TENS, or NMES) promote recovery, reduce pain, or improve functional mobility in post-operative hip fracture patients?

My name is Paul Davison and I am a physiotherapy Masters student at Queen's University in Kingston, ON Canada. As part of my degree, I am completing a scoping review on the efficacy of using electrical stimulation to promote better health outcomes in post-operative hip fracture patients.

Thus far, we have found that the literature is extremely limited as our analysis included only 4 journal articles after reviewing 432 citations. Our search criteria are available upon request. Results have demonstrated some significant positive results to support the use of electrical stimulation (especially for the purpose of pain management) with this population.

I am posting here as a means of reaching out to the community for any suggestions to help improve the strength of our review. This may include any research you are aware of, personal opinions or ideas, suggestions for future research, or anything else you would like to share.

I would just like to thank you for spending the time to read up on this project and offering any potential insight you may have!

Paul Davison

Paul Davison

2 months ago

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Prof Alison Hoens
Prof Alison Hoens

Hello Paul Great idea to reach out to the international PT community for further insight/direction. The key to this, and similar situations in which one is attempting to ascertain 'effectiveness' from a review of the literature, is to pay particular attention to the methods ie. the parameters selected (pulse duration, amplitude, number of contractions etc, the application (electrode size, distance, location; treatment duration, treatment frequency, number of sessions). I suggest that you refer to the publication by my colleagues and I (https://www.ncbi.nlm.nih.gov/pubmed/29162949), for further understanding of these issues. It is important to recognize that a modality is not 'always effective' nor 'never effective' but rather that the combination of the 'right/appropriate modality' with the 'right/appropriate methods' be used. For example, if the pulse duration and frequency utilized is more specific to sensory nerve depolarization (e.g TENS at 60 microsec and 250 Hz) and the outcome measure used is related to muscle strength it is highly unlikely that there will be a change in muscle strength (typically requiring 350-400 microsec at approx 50 Hz). Take home message: don't just report the conclusions of the authors of the studies but instead critically evaluate the methods that were used in order to determine whether the selected outcome measures are likely to be sensitive, specific and appropriate for the desired effect e.g. pain management vs muscle strengthening. Hope this helps.

17rw12439
17rw12439

Thanks for this reply!

17pjd437
17pjd437

Initially, our search aimed to explore any clinical outcome that has been investigated in an elderly post-operative hip fracture population. The intervention could be any form of inexpensive electrical stimulation used as a physiotherapy modality (i.e. TENS, NMES, IFC).

As of this point, TENS-like electrical stimulation has been shown to reduce pain after hip fractures, and therefore functioned as a means to increase ROM and functional mobility. This study also suggested that length of stay may be decreased as discharge criteria were met in less time (while also using less pain medications) - but future research needs to address this idea.

Results for NMES are less definitive, showing that elderly post-operative hip fracture patients may not tolerate the intensity required to elicit quadriceps strength gains. But, the idea behind it is to improve quadriceps strength to promote balance and walking. Balance, being measured through postural sway. These studies also showed no changes in usual gait speed, leg extensor power, functional mobility and disability.

That being said, we are not limiting the scope of the review to pain and functional mobility, these are merely the outcomes the literature have addressed thus far.

Thank you for your response!

lochingai197
lochingai197

See if you don't mind, could you please share the ideas of the PICO so can give more specific suggestions.

I could see pain relief is a positive but very general effect of electrical stimulation. It may not be specific for hip fracture.

How about balance? Mobility? Length of stay etc?

Last updated 2 months ago

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