Abdominal FES (v no intervention) on stimulated cough in people with SCI who have abdominal muscle weakness or paralysis | SCI Physiotherapy Clinical Practice Guidelines

	Abdominal FES (v no intervention) on stimulated cough in people with SCI who have abdominal muscle paralysis or weakness
P	People with SCI who have abdominal muscle paralysis or weakness	Evidence recommendation No evidence recommendation Reason: No recommendation due to insufficient or inconclusive evidence.		Weak opinion statement FOR Abdominal FES may be provided to improve stimulated cough in people with SCI who have abdominal muscle paralysis or weakness.
I	Abdominal FES
C	No intervention	Consensus-based opinion statement Weak for (92%)
O	Secretion clearance	Consensus-based opinion statement Weak for (92%)
	SUMMARY	1 RCT (see reference)		Mean difference (95% CI): Peak Expiratory Flow in Litres 1.0 (0.4 to 1.7) Favours abdominal FES
	GRADE Very low certainty ⨁◯◯◯	Risk of bias Serious	Inconsistency Serious	Imprecision Not serious	Indirectness Not serious	Publication bias Serious

ABDOMINAL FES ON PEAK EXPIRATORY FLOW: GRADE Evidence to Decision
PROBLEM	No	Probably no	Probably yes	Yes		Don't know
DESIRABLE EFFECTS	Trivial	Small	Moderate	Large		Don't know
UNDESIRABLE EFFECTS	Large	Moderate	Small	Trivial		Don't know
CERTAINTY OF EVIDENCE	Very low	Low	Moderate	High		No included studies
HOW MUCH PEOPLE VALUE THE MAIN OUTCOME	Important uncertainty or variability	Possibly important uncertainty or variability	Probably no important uncertainty or variability	No important uncertainty or variability
BALANCE OF EFFECTS	Favours the Control	Probably favours the Control	Does not favour either the intervention (I) or the comparison (C)	Probably favours the I	Favours the I	Don't know
RESOURCES REQUIRED	Large costs	Moderate costs	Negligible costs and savings	Moderate savings	Large savings	Don't know
CERTAINTY OF EVIDENCE OF REQUIRED RESOURCES	Very low	Low	Moderate	High		No included studies
COST EFFECTIVENESS	Favours the comparison	Probably favours the comparison	Does not favour either the intervention or the comparison	Probably favours the intervention	Favours the intervention	No included studies
EQUITY	Reduced	Probably reduced	Probably no impact	Probably increased	Increased	Don't know
ACCEPTABILITY	No	Probably no	Probably yes	Yes		Don't know
FEASIBILITY	No	Probably no	Probably yes	Yes		Don't know

ABDOMINAL FES FOR PEAK EXPIRATORY FLOW: Randomised Controlled Trial Details
STUDY	COMPARISON	DOSAGE/DETAILS	PARTICIPANTS	N (Rx/C)	OUTCOME	ROB 2 PEDRo
CHENG 2006	NMES plus usual care V Usual Care	NMES 30Hz; pulse width 300µs; on/off 4/4s; Intensity 0 to 100mA.	C4-C7 SCI AIS A, B <3 months post injury	13/13	Peak Expiratory Flow (PEF)	Some concerns about Risk of Bias PEDro = 5/10

The Australian and NZ SCI Physiotherapy guideline committee recommends abdominal FES to improve stimulated cough in people with SCI who have abdominal muscle weakness or paralysis. This is a consensus-based opinion statement supported by the opinions of the experts even though there are randomised controlled trials related to this topic. The results of these randomised controlled trials are either contradictory or inconclusive preventing an evidence recommendation. The guideline states:

Abdominal FES may be provided to improve stimulated cough in people with SCI who have abdominal muscle weakness or paralysis.

This statement was formed by considering the balance between benefits and harms, values and preferences, resource use, personal experience, equity, accessibility, feasibility and personal experience. The results of the two randomised controlled trials were also taken into consideration.

This is a consensus-based opinion statement. Consensus-based opinion statements are less robust than evidence-based recommendations. They can be strong or weak. This is a weak consensus-based opinion statement which means that the guideline panel is confident they can probably recommend abdominal FES to improve stimulated cough in people with SCI who have abdominal muscle weakness or paralysis based on opinion.

To learn more about the this intervention go to the research evidence.

Cheng, P.Chen, C.Wang, C.Chung, C. Effect of neuromuscular electrical stimulation on cough capacity and pulmonary function in patients with acute cervical cord injury. Journal of Rehabilitation Medicine 2006 Jan;38(1):32-36.