The effectiveness of transcutaneous neuromuscular electrical stimulation (NMES) on adults with post-stroke dysphagia : a systematic review

Abstract

Objective: This systematic review evaluated the short-term and long-term effectiveness of transcutaneous neuromuscular electrical stimulation (NMES), the effects of different electrode placements and whether NMES can benefit patients with different pathophysiologies. Methods: This systematic review followed the framework of Cochrane Handbook for Systematic Review of Interventions. Twenty-eight electronic databases were searched to identify studies published from 1 January 2016 to 12 January 2018 for controlled clinical trials and randomized controlled trials that used NMES to treat post-stroke dysphagia. The studies were appraised using the Scottish Intercollegiate Guidelines Network (SIGN) methodology checklist for controlled trials. Results: Nine English studies were included. All contained methodological flaws that reduced the quality of the evidence. Conclusion: There is insufficient evidence regarding the effects of NMES for post-stroke dysphagia for motor and sensory stimulation. There is no consensus regarding which electrode placement is more effective. The effects of NMES on oral phase of swallowing are not established and it is unknown whether NMES can improve a specific type of pathophysiology. Further high-quality randomized controlled trials are needed.