Neuromuscular electrical stimulation in the management of peripheral arterial disease and muscle recovery
Creators: name: Babber, Adarsh
Publisher: name: Imperial College London
Year: 2018

description: Background and Aim Peripheral arterial disease (PAD) has a significant global health and economic burden. Intermittent claudication (IC) is an early manifestation of PAD, causing significant functional disability and poor quality of life (QoL). Management includes lifestyle and atherosclerotic risk factor modification. A supervised exercise programme (SEP) is the recommended first line strategy, showing significant improvements in pain free walking distance. This is underutilised and inaccessible to the majority in the UK. Neuromuscular electrical stimulation (NMES) is an evolving novel technology showing potential for use in vascular disease. The aim of this study was to assess the utility of NMES in the management of PAD, as an adjunct to SEPs and in muscle recovery following fatigue. Methods Background research included assessment of the outcomes associated with a local SEP, a national online audit of access to SEPs in UK and Ireland and a literature review on current evidence of the utility of NMES in IC. National ethics and regulatory approval was gained for NMES based research in PAD. Patients were recruited from the vascular outpatient clinic at Charing Cross Hospital. Two planned PAD studies were completed as follows: 1: NMES in the management of IC - a proof of concept study of the independent effect of 6 weeks intervention with NMES. 2: The adjuvant benefit of NMES to SEPs in the management of IC - a randomised controlled study to assess the adjunctive benefit of NMES to SEPs, comparing a control group receiving SEP only with another receiving SEP and footplate NMES, for 6 weeks. Outcomes included treadmill walking distances, disease specific and generic QoL scores, haemodynamic measures of the superficial femoral artery (Duplex ultrasound) and skin microcirculation (Laser Doppler Flowmetry). Ethics approval was gained for muscle recovery studies, recruiting healthy volunteers from Imperial College London and Kings College London. Two studies were undertaken: 1: Use of NMES in muscle recovery following high intensity exercise – a pilot randomised controlled study assessing the utility of NMES compared to passive rest in calf muscle recovery following high intensity exercise. 2: Use of NMES in the recovery of short and long term calf muscle fatigue – a randomised controlled trial assessing the utility of NMES compared to passive rest in muscle recovery following calf muscle fatigue over time. Outcomes assessed muscle performance by vertical jump test and numeric rating scale (NRS) for pain. Results NMES showed significant improvements in functional ability and both disease specific and generic QoL following 6 weeks intervention. There was a significant adjuvant benefit of NMES compared to SEP in improving the initial claudication distance in patients with IC following 6 weeks intervention as well as disease specific quality of life score. Blood flow and Time Averaged Mean Velocity increased significantly whilst the device was on. There were no significant improvements in calf muscle recovery following fatigue in healthy individuals. Conclusions Functional and QoL measures were improved by NMES intervention. These clinical trials provide a good foundation for further robust clarification of the utility of NMES in PAD. Exploration of the mechanisms by which this may occur, is also needed.