As a result, a total of 5950 papers were identified. According to inclusion and exclusion criteria, 4 articles were finally screened.. In total, 2 eligible.
Data extraction
The study's author, aim, Design, Participants, Intervention, assessment tool, and conclusion were extracted in Table (2).
Table (2) – Table of Characteristics
Author
|
Aim
|
Design
|
Participants
(n)
|
Intervention
|
Assessment tool
|
conclusion
|
Moroder et al., 2024 [11]
|
The hypothesis of this study was that NMES-enhanced physical therapy leads to better outcomes than physical therapy alone as the current gold standard of treatment in patients with FPSI
|
RCT
|
59 (24 NMES-PT Intervention, 25 Control)
|
Control Group: PT Exercises Alone.
Interventional Group: PT Exercises combined with NMES (35HZ) /181-hour training sessions (distributed over a period of 6 weeks)
|
WOSI
SANE
|
In comparison to conventional physical therapy alone, the current study demonstrates that NMES-enhanced physical therapy led to statistically significant and clinically relevant improvements in outcomes in the treatment of FPSI. These improvements can be beneficial even for patients who have previously had unsatisfactory outcomes from conventional physical therapy.
|
Hong et al., 2021 [12]
|
to investigate whether position-triggered ES was more effective in reducing acute hemiplegic shoulder subluxation after stroke than passive ES
|
RCT
|
50 (25 Position triggered ES, 25 Passive ES
|
PT Rehabilitation Program included positioning, range of
motion, stretching, and strengthening exercises (5 times a week lasting 30 min each for 3 weeks)
ES: a biphasic waveform, pulse duration of 300µs. Pulse frequency: 30
Hz. stimulation cycle was 5 seconds on and 5 seconds
Off.
(30-minutes of
ES every week, 5 days/week for 3-week periods)
|
X-ray
Fugl-Meyer Assessment
Motricity Index
Manual function test
dynamometer
|
In order to improve poststroke shoulder subluxation, position-triggered ES may be more beneficial than passive ES; however, this effect was not maintained after the withdrawal of stimulation.
|
*NMES: Neuromuscular Electrical Stimulation, *FPSI: Functional Posterior Shoulder Instability, *ES: Electrical Stimulation, *RCT: Randomized Controlled Trial, *PT: Physical Therapy, *HZ: Hertz, *Min: Minute, * µs: Microsecond, * WOSI: Western Ontario Shoulder Instability Index, * SANE: Single Assessment Numeric Evaluation.
|
Risk of bias assessment
The risk of bias of the included studies was assessed using Cochrane risk of bias tool for randomized controlled trials [13] (Table 3).
Table (3) - Risk of bias
Study
|
Random sequence generation
|
Allocation concealment
|
Blinding of participants and personnel
|
Incomplete
outcome data
|
Selective
reporting
|
Other bias
|
Moroder et al., 2024 [11]
|
Low
|
Low
|
Unclear
|
Low
|
Low
|
Unclear
|
Hong et al., 2021 [12]
|
Low
|
Unclear
|
High
|
Low
|
Low
|
Low
|
Moroder et al., 2024 [11] included (59) participants (24 NMES-PT Intervention, 25 Control); the treatment protocol lasts for (6) weeks with (4) times assessment (6 weeks, 3 months, 6 months, 12 months) respectively; The follow-up rates were 85.7% for the primary endpoint at 3 months and 71.4% for the final follow-up at 1 year. The NMES-enhanced physical therapist group showed a significantly better main outcome measurement in terms of the 3-month WOSI score (64%) than the physical therapist group (51%). No significant differences in terms of the SANE score and pain at rest or during motion were observed between groups at the 3-month follow-up. The frequency of instability episodes showed a significant improvement in the NMES-enhanced physical therapist group at the 3-month follow-up (P = .001) and beyond (6 months: P = .001; 12 months: P = .004), while in the physical therapist group no statistically significant difference was observed (P = .481). The majority of patients in both groups were still able to freely dislocate their shoulders. Ninety-five percent of patients in the NMES-enhanced physical therapy group reported a subjective improvement in their symptoms, compared to sixty-three percent of patients in the physical therapy group (P = .024).
Hong et al., 2021 [12] included (50) participants (25 Position triggered ES, 25 Passive ES); both groups exposed to PT Rehabilitation Program followed by ES (Two electrodes were applied on the affected supraspinatus and posterior deltoid muscles in all subjects. The reference electrode was placed over the supraspinatus muscle to minimize undesirable activation of the overlying upper trapezius muscle), For setting the trigger-orienting angle generating ES signal, Hong et al., 2021 [12] asked all patients enrolled in the position-triggered ES group to abduct the shoulder 10 times voluntarily before ES. The median angle and angular velocity were calculated using the accelerometer built-in gyroscope during repetitive shoulder movement, and the median angle was set as the trigger-orienting angle. All subjects received the following assessments at baseline (T0), at the end of treatment (T1), and at 3 weeks after treatment (T2). After the x-ray assessment; the study showed significant interaction in Shoulder subluxation between TIME (T0, T1, and T2) and INTERVENTION (position-triggered ES, passive ES) on JD and rJD scores, but did not reveal significant interaction on VD and rVD scores. ∆rVD, ∆JD, and ∆rJD in the position-triggered ES group significantly improved at T1 compared to those in the passive ES group (P < 0.05). ∆VD tended to improve at T1 in the position-triggered ES group compared to that in the passive ES group; however, this difference was not significant (P = 0.138) interestingly, ∆VD, ∆rVD, ∆JD, and ∆rJD did not show any significant difference at T2 between the groups. After the Motor function assessment; the study showed not differ significantly among the three groups in (FMA upper, MI, MFT, and PT).