Electrical stimulation alone (v no intervention) on voluntary strength of partially paralysed muscles in people with SCI | SCI Physiotherapy Clinical Practice Guidelines

	Electrical stimulation alone (v no intervention) on voluntary strength of partially paralysed muscles in people with SCI
P	People with SCI (partially-paralysed muscles)	Evidence recommendation Weak Against (96%)		Weak evidence recommendation AGAINST Electrical stimulation alone should not be provided to improve voluntary strength of partially paralysed muscles in people with SCI. Clinical note: When electrical stimulation is used in partially paralysed muscles it should be combined with voluntary effort.
I	Electrical stimulation alone	Evidence recommendation Weak Against (96%)
C	No intervention	Consensus-based opinion statement No opinion statements
O	Voluntary strength
	SUMMARY	1 RCT (see reference)		Mean difference (95% CI): Strength in Nm 0 (-0.5 to 0.6) Favours electrical stimulation
	GRADE Very low certainty ⨁◯◯◯	Risk of bias Serious	Inconsistency Serious	Imprecision No serious	Indirectness Serious	Publication bias Serious

ELECTRICAL STIMULATION ON VOLUNTARY STRENGTH PARTIALLY PARALYSED MUSCLES: 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

ELECTRICAL STIMULATION ON VOLUNTARY STRENGTH PARTIALLY PARALYSED MUSCLES: Randomised Controlled Trial Details
STUDY	COMPARISON	DOSAGE/DETAILS	PARTICIPANTS	N (Rx/C)	OUTCOME	ROB 2 PEDRo
GLINSKY 2009	Strength training plus ES V Strength training and Sham ES	6 sets of 10 Reps, 3 x per week for 8 weeks	C4 to C7 tetraplegia	32/32	Strength in Nm	Some Concerns of Risk of Bias PEDro = 9/10

The Australian and NZ SCI Physiotherapy guideline committee recommends against electrical stimulation alone to improve voluntary strength of partially paralysed muscles in people with SCI.This is an evidence recommendation supported by the results of one randomised controlled trial. The guideline states:

Electrical stimulation alone should not be provided to improve voluntary strength of partially paralysed muscles in people with SCI.

This recommendation was formed by considering the results of one randomised controlled trial alongside other factors. The trial results indicate that electrical stimulation alone is not better than no electrical stimulation to improve strength. The other factors that were considered were benefits and harms, values and preferences, resource use, equity, accessibility, and feasibility.

This is an evidence-based recommendation. Evidence-based recommendations are more robust than consensus-based opinion statements. They can be strong or weak. This is a weak evidence-based recommendation which means the guideline panel is confident that they can probably recommend against electrical stimulation alone to improve voluntary strength of partially paralysed muscles in people with SCI based on evidence.

To learn more about this recommendation go to the research summary.

Glinsky J, Harvey L, van Es P, et al. The addition of electrical stimulation to progressive resistance training does not enhance the wrist strength of people with tetraplegia: a randomized controlled trial. Clinical rehabilitation 2009; 23: 696-704.