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Diseases (Basel, Switzerland) Nov 2023Prolonged COVID is a persistent condition following the initial COVID-19 infection, which is characterized by a variety of symptoms that may include fatigue, muscle... (Review)
Review
Prolonged COVID is a persistent condition following the initial COVID-19 infection, which is characterized by a variety of symptoms that may include fatigue, muscle pain, sleep disturbances, "brain fog", respiratory, cardiovascular, digestive, neurological and dermatological symptoms. Physical therapy has been identified as a crucial aspect of the management of patients with long COVID, as it can help improve symptoms and overall physical function. The investigation of long COVID poses significant challenges due to the diversity and variability of symptoms, lack of clear diagnostic criteria, and limited understanding of the underlying mechanisms. The aim of this study is to conduct a systematic review of studies conducted in patients with long COVID in conjunction with interventions targeting respiratory function, particularly involving physical activity. To this end, we conducted a systematic review to analyze studies conducted on treatment programs for long COVID based on some form of physical activity. The protocol of the review was registered in the PROSPERO website, and the databases PubMed, Scopus, CINAHL and WOS were searched. Of the 62 initial articles, six were included in the review. The results obtained have positive implications for the advancement of physical activity as a therapeutic intervention for individuals with long COVID-19 and the conceptualization of evidence-based treatment protocols. Statistically significant results have been observed in studies of at least 6 weeks duration, in which inspiratory muscle training exercises are proposed. Further research is needed to better understand long COVID and develop effective treatment strategies.
PubMed: 37987274
DOI: 10.3390/diseases11040163 -
Archives of Academic Emergency Medicine 2022Knowledge of the safety of vaccines is crucial, both to prevent and cure them and to decrease the public hesitation in receiving vaccines. Therefore, this study aimed to... (Review)
Review
INTRODUCTION
Knowledge of the safety of vaccines is crucial, both to prevent and cure them and to decrease the public hesitation in receiving vaccines. Therefore, this study aimed to systematically review the adverse events reported for inactivated vaccines and Novavax.
METHODS
In this systematic review, the databases of PubMed, Scopus, Cochrane, and Web of Science were searched on September 15, 2021. Then we identified the eligible studies using a two-step title/abstract and full-text screening process. Data on the subjects, studies, and types of adverse events were extracted and entered in a word table, including serious, mild, local, and systemic adverse events as well as the timing of side effects' appearance.
RESULTS
Adverse effects of inactivated coronavirus vaccines side effects were reported from phases 1, 2, and 3 of the vaccine trials. The most common local side effects included injection site pain and swelling, redness, and pruritus. Meanwhile, fatigue, headache, muscle pain, fever, and gastrointestinal symptoms including abdominal pain and diarrhea were among the most common systemic adverse effects.
CONCLUSION
This systematic review indicates that inactivated COVID-19 vaccines, including Sinovac, Sinopharm, and Bharat Biotech, as well as the protein subunit vaccines (Novavax) can be considered as safe choices due to having milder side effects and fewer severe life-threatening adverse events.
PubMed: 36033990
DOI: 10.22037/aaem.v10i1.1585 -
The Cochrane Database of Systematic... Jan 2023Alcohol use disorder (AUD) is one of the most widespread psychiatric disorders leading to detrimental consequences to people with this disorder and others. Worldwide,... (Review)
Review
BACKGROUND
Alcohol use disorder (AUD) is one of the most widespread psychiatric disorders leading to detrimental consequences to people with this disorder and others. Worldwide, the prevalence of heavy episodic drinking (30-day prevalence of at least one occasion of 60 g of pure alcohol intake among current drinkers) is estimated at 20% and the prevalence of AUD at 5% of the adult general population, with highest prevalence in Europe and North America. Therapeutic approaches, including pharmacotherapy, play an important role in treating people with AUD. This is an update of a Cochrane Review first published in 2018.
OBJECTIVES
To evaluate the benefits and harms of baclofen on achieving and maintaining abstinence or reducing alcohol consumption in people with AUD compared to placebo, no treatment or any other pharmacological relapse prevention treatment.
SEARCH METHODS
We used standard, extensive Cochrane search methods. The latest search was 22 November 2021.
SELECTION CRITERIA
Randomised controlled trials (RCTs) of at least four weeks' treatment duration and 12 weeks' overall study duration comparing baclofen for AUD treatment with placebo, no treatment or other treatments.
DATA COLLECTION AND ANALYSIS
We used standard Cochrane methods. Our primary outcomes were 1. relapse, 2. frequency of use, 3. amount of use, 4. adverse events, 5. dropouts from treatment and 6. dropouts from treatment due to adverse events. Our secondary outcomes were 7. craving, 8. anxiety, 9. depression and 10. frequency of most relevant adverse events.
MAIN RESULTS
We included 17 RCTs (1818 participants) with a diagnosis of alcohol dependence according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition or International Classification of Diseases 10th edition criteria. Mean age was 46.5 years and 70% were men. Ten studies compared baclofen to placebo or another medication; seven compared two baclofen doses to placebo or another medication. Globally, 15 studies compared baclofen to placebo, two baclofen to acamprosate and two baclofen to naltrexone. In 16 studies, participants received psychosocial treatments. We judged most studies at low risk of selection, performance, detection (subjective outcome), attrition and reporting bias. Ten studies detoxified participants before treatment; in seven studies, participants were still drinking at the beginning of treatment. Treatment duration was 12 weeks for 15 RCTs and longer in two studies. Baclofen daily dose was 30 mg to 300 mg: 10 RCTs used low doses (30 mg or less); eight RCTs medium doses (above 30 and 100 mg or less) and four RCTs high doses (above 100 mg). Compared to placebo, moderate-certainty evidence found that baclofen probably decreases the risk to relapse (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.77 to 0.99; 12 studies, 1057 participants). This result was confirmed among detoxified participants but not among other subgroups of participants. High-certainty evidence found that baclofen increases the percentage of days abstinent (mean difference (MD) 9.07, 95% CI 3.30 to 14.85; 16 studies, 1273 participants). This result was confirmed among all subgroups of participants except non-detoxified or those who received medium doses. There was no difference between baclofen and placebo in the other primary outcomes: heavy drinking days (standardised mean difference (SMD) -0.18, 95% CI -0.48 to 0.11; 13 studies, 840 participants; moderate-certainty evidence); number of drinks per drinking days (MD -0.45, 95% CI -1.20 to 0.30; 9 studies, 392 participants; moderate-certainty evidence); number of participants with at least one adverse event (RR 1.05, 95% CI 0.99 to 1.11; 10 studies, 738 participants; high-certainty evidence); dropouts (RR 0.88, 95% CI 0.74 to 1.03; 17 studies, 1563 participants; high-certainty evidence); dropouts due to adverse events (RR 1.39, 95% CI 0.89 to 2.18; 16 studies, 1499 participants; high-certainty evidence). These results were confirmed by subgroup analyses except than for the dropouts that resulted lower among participants who received high doses of baclofen and studies longer than 12 weeks. Compared to placebo, there was no difference in craving (SMD -0.16, 95% CI -0.37 to 0.04; 17 studies, 1275 participants), anxiety (MD -0.01, 95% CI -0.14 to 0.11; 15 studies, 1123 participants) and depression (SMD 0.07, 95% CI -0.12 to 0.27; 11 studies, 1029 participants). Concerning the specific adverse events, baclofen increases fatigue, dizziness, somnolence/sedation, dry mouth, paraesthesia and muscle spasms/rigidity. There was no difference in the other adverse events. Compared to acamprosate, one study (60 participants) found no differences in any outcomes but the evidence was very uncertain: relapse (RR 1.25, 95% CI 0.71 to 2.20; very low-certainty evidence); number of participants with at least one adverse event (RR 0.63, 95% CI 0.23 to 1.69; very low-certainty evidence); dropouts (RR 0.56, 95% CI 0.21 to 1.46; very low-certainty evidence); dropouts due to adverse events (RR 0.33, 95% CI 0.01 to 7.87; very low-certainty evidence) and craving (MD 5.80, 95% CI -11.84 to 23.44); and all the adverse events evaluated. Compared to naltrexone, baclofen may increase the risk of relapse (RR 2.50, 95% CI 1.12 to 5.56; 1 study, 60 participants; very low-certainty evidence) and decrease the number of participants with at least one adverse event (RR 0.35, 95% CI 0.15 to 0.80; 2 studies, 80 participants; very low-certainty evidence) but the evidence is very uncertain. One study (60 participants) found no difference between baclofen and naltrexone in the dropouts at the end of treatment (RR 1.00, 95% CI 0.32 to 3.10; very low-certainty evidence), craving (MD 2.08, 95% CI -3.71 to 7.87), and all the adverse events evaluated.
AUTHORS' CONCLUSIONS
Baclofen likely reduces the risk of relapse to any drinking and increases the percentage of abstinent days, mainly among detoxified participants. It does not increase the number of participants with at least one adverse event, those who dropout for any reason or due to adverse events. It probably does not reduce number of heavy drinking days and the number of drinks per drinking days. Current evidence suggests that baclofen may help people with AUD in maintaining abstinence. The results of comparisons of baclofen with acamprosate and naltrexone were mainly based on only one study.
Topics: Adult; Female; Humans; Male; Middle Aged; Acamprosate; Alcohol Drinking; Alcoholism; Baclofen; Chronic Disease; Naltrexone
PubMed: 36637087
DOI: 10.1002/14651858.CD012557.pub3 -
Brain and Behavior Apr 2022Caffeine is often used as a stimulant during fatigue, but the standard of characteristic physiological indicators of the effect of caffeine on neuromuscular fatigue has... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Caffeine is often used as a stimulant during fatigue, but the standard of characteristic physiological indicators of the effect of caffeine on neuromuscular fatigue has not been unified. The purpose of this systematic review and meta-analysis is to summarize current experimental findings on the effects of caffeine on physiological indexes before and after neuromuscular fatigue, identify some characteristic neuromuscular physiological indexes to assess the potential effects of caffeine.
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-analyses are followed. We systematically searched PubMed, Google academic, and Web of Science for randomized controlled trials. We searched for studies on caffeine's (i) effects on neuromuscular fatigue and (ii) the influence of physiological indexes changes. Meta-analysis was performed for standardized mean differences (SMD) between caffeine and placebo trials in individual studies.
RESULTS
The meta-analysis indicated that caffeine significantly improves voluntary activation (VA) (SMD = 1.46;95%CI:0.13, 2.79; p < .00001), PTw (SMD = 1.11, 95%CI: -1.61, 3.84; p < .00001), and M-wave (SMD = 1.10, 95%CI: -0.21, 2.41; p < .00001), and a significant difference (p = .003) on measures of Peak Power (PP), and insignificant difference on measures of heart rate (HR) (I = 0.0, p = .84) and Maximal oxygen uptake (VO ) (I = 0.0, p = .76).
CONCLUSION
The analysis showed that caffeine intake had a relatively large effect on VA, potentiated twitch (PTw), M-wave, which can be used as characteristic indexes of caffeine's impact on neuromuscular fatigue. This conclusion tends to indicate the effects of caffeine on neuromuscular fatigue during endurance running or jumping or muscle bending and stretching. The caffeine intake had a big effect on the electromyogram (EMG) and peak power (PP), and its effect role needs to be further verified, this conclusion tends to indicate the effect of caffeine on neuromuscular fatigue during jumping or elbow bending moment movements. HR, VO , maximal voluntary contraction (MVC) cannot be used as the characteristic indexes of caffeine on neuromuscular fatigue. This conclusion tends to indicate the effect of caffeine on neuromuscular fatigue during endurance exercise. However, the results of meta-analysis are based on limited evidence and research scale, as well as individual differences of participants and different physical tasks, so it is necessary to interpret the results of meta-analysis cautiously. Therefore, future research needs to explore other physiological indicators and their indicative effects in order to determine effective and accurate characteristic indicators of caffeine on neuromuscular fatigue.
Topics: Caffeine; Central Nervous System Stimulants; Eating; Electromyography; Humans; Muscle Fatigue
PubMed: 35318818
DOI: 10.1002/brb3.2529 -
BMC Sports Science, Medicine &... Jan 2024Volleyball, with its unique calendar structure, presents distinct challenges in training and competition scheduling. Like many team sports, volleyball features an...
BACKGROUND
Volleyball, with its unique calendar structure, presents distinct challenges in training and competition scheduling. Like many team sports, volleyball features an unconventional schedule with brief off-season and pre-season phases, juxtaposed against an extensive in-season phase characterized by a high density of matches and training. This compact calendar necessitates careful management of training loads and recovery periods. The effectiveness of this management is a critical factor, influencing the overall performance and success of volleyball teams. In this review, we explore the associations between training stress measures, fatigue, and well-being assessments within this context, to better inform future research and practice.
METHODS
A systematic literature search was conducted in databases including PsycINFO, MEDLINE/PubMed, SPORTDiscus, Web of Science, and Scopus. Inclusion criteria were original research papers published in peer-reviewed journals involving volleyball athletes.
RESULTS
Of the 2535 studies identified, 31 were thoroughly analysed. From these 31 articles, 22 included professional athletes, seven included collegiate-level volleyball athletes, and two included young athletes. Nine studies had female volleyball players, while the remaining 22 had male volleyball athletes.
CONCLUSIONS
Internal training load should be collected daily after training sessions and matches with the session rating of perceived exertion method. External training load should also be measured daily according to the methods based on jump height, jump count, and kinetic energy. If force platforms are available, neuromuscular fatigue can be assessed weekly using the FT:CT ratio of a countermovement jump or, in cases where force platforms are not available, the average jump height can also be used. Finally, the Hooper Index has been shown to be a measure of overall wellness, fatigue, stress, muscle soreness, mood, and sleep quality in volleyball when used daily.
PubMed: 38218879
DOI: 10.1186/s13102-024-00807-7 -
The British Journal of Surgery Jan 2024While fatigue is an inevitable aspect of performing surgical procedures, lack of consensus remains on its effect on surgical performance. The aim of this systematic...
BACKGROUND
While fatigue is an inevitable aspect of performing surgical procedures, lack of consensus remains on its effect on surgical performance. The aim of this systematic review was to assess the effect of non-muscular fatigue on surgical outcome.
METHODS
MEDLINE and Embase were searched up to 17 January 2023. Studies on students, learning, duty-hour restrictions, muscle fatigue, non-surgical or subjective outcome, the weekend effect, or time of admission were excluded. Studies were categorized based on real-life or simulated surgery. The Cochrane risk-of-bias tool was used to assess RCTs and the Newcastle-Ottawa scale was used to assess cohort studies. Due to heterogeneity among studies, data pooling was not feasible and study findings were synthesized narratively.
RESULTS
From the 7251 studies identified, 134 studies (including 1 684 073 cases) were selected for analysis (110 real-life studies and 24 simulator studies). Of the simulator studies, 46% (11 studies) reported a deterioration in surgical outcome when fatigue was present, using direct measures of fatigue. In contrast, only 35.5% (39 studies) of real-life studies showed a deterioration, observed in only 12.5% of all outcome measures, specifically involving aggregated surgical outcomes.
CONCLUSION
Almost half of simulator studies, along with one-third of real-life studies, consistently report negative effects of fatigue, highlighting a significant concern. The discrepancy between simulator/real-life studies may be explained by heightened motivation and effort investment in real-life studies. Currently, published fatigue and outcome measures, especially in real-life studies, are insufficient to fully define the impact of fatigue on surgical outcomes due to the absence of direct fatigue measures and crude, post-hoc outcome measures.
Topics: Humans; Outcome Assessment, Health Care; Cohort Studies; Surgeons; Learning
PubMed: 38097353
DOI: 10.1093/bjs/znad397 -
The Cochrane Database of Systematic... May 2023The finding that exercise is inversely related to metabolic syndrome after transplantation is novel and suggests that exercise interventions might provide a means for... (Review)
Review
BACKGROUND
The finding that exercise is inversely related to metabolic syndrome after transplantation is novel and suggests that exercise interventions might provide a means for reducing metabolic syndrome complications in liver transplantation recipients. The use of exercise for increasing the physical activity daily levels by more frequent, higher intensity, and longer duration of training sessions, or the sum of these components may be necessary to counteract the effects of the pretransplant reduced activity, metabolic disturbances, and post-transplant immunosuppression, as well as improve physical function and aerobic capacity following liver transplantation. Regular physical activity has a long-term positive impact on recovery following various surgical procedures including transplantation, giving people the opportunity to return to an active life with their families, in society, and in their professional life. Likewise, specific muscle strength training may attenuate the loss of strength after liver transplantation.
OBJECTIVES
To evaluate the benefits and harms of exercise-based interventions in adults after liver transplantation compared to no exercise, sham interventions, or another type of exercise.
SEARCH METHODS
We used standard, extensive Cochrane search methods. The latest search date was 2 September 2022.
SELECTION CRITERIA
We included randomised clinical trials in liver transplantation recipients comparing any type of exercise with no exercise, sham interventions, or another type of exercise.
DATA COLLECTION AND ANALYSIS
We used standard Cochrane methods. Our primary outcomes were 1. all-cause mortality; 2. serious adverse events; and 3. health-related quality of life. Our secondary outcomes were 4. a composite of cardiovascular mortality and cardiac disease; 5. aerobic capacity; 6. muscle strength; 7. morbidity; 8. non-serious adverse events; and 9. cardiovascular disease post-transplantation. We assessed risk of bias of the individual trials using RoB 1, described the interventions using the TIDieR checklist, and used GRADE to assess certainty of evidence.
MAIN RESULTS
We included three randomised clinical trials. The trials randomised 241 adults with liver transplantation, of which 199 participants completed the trials. The trials were conducted in the USA, Spain, and Turkey. They compared exercise versus usual care. The duration of the interventions ranged from two to 10 months. One trial reported that 69% of participants who received the exercise intervention were adherent to the exercise prescription. A second trial reported a 94% adherence to the exercise programme, with participants attending 45/48 sessions. The remaining trial reported a 96.8% adherence to the exercise intervention during the hospitalisation period. Two trials received funding; one from the National Center for Research Resources (US) and the other from Instituto de Salud Carlos III (Spain). The remaining trial did not receive funding. All trials were at an overall high risk of bias, derived from high risk of selective reporting bias and attrition bias in two trials. The results on all-cause mortality showed a higher risk of death in the exercise group versus the control group, but these results are very uncertain (risk ratio (RR) 3.14, 95% confidence interval (CI) 0.74 to 13.37; 2 trials, 165 participants; I² = 0%; very low-certainty evidence). The trials did not report data on serious adverse events excluding mortality or non-serious adverse events. However, all trials reported that there were no adverse effects associated with exercise. We are very uncertain on whether exercise compared with usual care has a beneficial or harmful effect on health-related quality of life assessed using the 36-item Short Form Physical Functioning subscale at the end of the intervention (mean difference (MD) 10.56, 95% CI -0.12 to 21.24; 2 trials, 169 participants; I² = 71%; very low-certainty evidence). None of the trials reported data on composite of cardiovascular mortality and cardiovascular disease, and cardiovascular disease post-transplantation. We are very uncertain if there are differences in aerobic capacity in terms of VO at the end of the intervention between groups (MD 0.80, 95% CI -0.80 to 2.39; 3 trials, 199 participants; I² = 0%; very low-certainty evidence). We are very uncertain if there are differences in muscle strength at end of the intervention between groups (MD 9.91, 95% CI -3.68 to 23.50; 3 trials, 199 participants; I² = 44%; very low-certainty evidence). One trial measured perceived fatigue using the Checklist Individual Strength (CIST). Participants in the exercise group showed a clinically important lower degree of fatigue perception than participants in the control group, with a mean reduction of 40 points in the CIST (95% CI 15.62 to 64.38; 1 trial, 30 participants). We identified three ongoing studies.
AUTHORS' CONCLUSIONS
Based on very low-certainty evidence in our systematic review, we are very uncertain of the role of exercise training (aerobic, resistance-based exercises, or both) in affecting mortality, health-related quality of life, and physical function (i.e. aerobic capacity and muscle strength) in liver transplant recipients. There were few data on the composite of cardiovascular mortality and cardiovascular disease, cardiovascular disease post-transplantation, and adverse event outcomes. We lack larger trials with blinded outcome assessment, designed according to the SPIRIT statement and reported according to the CONSORT statement.
Topics: Humans; Adult; Liver Transplantation; Quality of Life; Cardiovascular Diseases; Metabolic Syndrome; Exercise Therapy; Fatigue
PubMed: 37204002
DOI: 10.1002/14651858.CD013204.pub2 -
Frontiers in Bioengineering and... 2024The electromechanical efficiency of skeletal muscle represents the dissociation between electrical and mechanical events within a muscle. It has been widely studied,...
The electromechanical efficiency of skeletal muscle represents the dissociation between electrical and mechanical events within a muscle. It has been widely studied, with varying methods for its measurement and calculation. For this reason, the purpose of this literature review was to integrate the available research to date and provide more insights about this measure. A systematic search of the literature was performed across three online databases: PubMed, ScienceDirect, and SPORTDiscus. This yielded 1284 reports, of which 10 met the inclusion criteria. Included studies have used different methods to measure the electromechanical efficiency (EME) index, including electromyography (EMG), mechanomyography and tensiomyography (TMG). The EME index was used to assess muscle conditions such as muscle atrophy, pain syndromes, or to monitor rehabilitation in patients with knee problems, fatigue and the effects of exercise and rehabilitation. TMG has been shown to be one of the most reliable methods to obtain the EME index, but its use precludes obtaining the index during voluntary muscle contractions. Standardizing the EME index is crucial for its diverse applications in clinical, sport, and rehabilitation contexts. Future research should prioritize standardization of measurement protocols for establishing the most repeatable, and reliable approach that can be used for inter-individual comparisons or for assessing an individual for multiple times over a longer period. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023440333 Identifier: CRD42023440333.
PubMed: 38784764
DOI: 10.3389/fbioe.2024.1398047 -
International Journal of Environmental... Sep 2022Recovery between efforts is critical to achieving optimal physical and sports performance. In this sense, many nutritional supplements that have been proven to improve... (Review)
Review
BACKGROUND
Recovery between efforts is critical to achieving optimal physical and sports performance. In this sense, many nutritional supplements that have been proven to improve recovery and physical and physiological performance are widely used. Supplements such as nitrates (NO), including organic foods such as beets, promote muscle recovery and relieve fatigue. This study aimed to comprehensively summarise the available literature on the effect of NO consumption on exercise-related fatigue and muscle damage.
METHODS
A systematic search was carried out based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) using electronic databases (e.g., PubMed, Scopus, and Web of Science). From a total of 1634 studies identified, 15 studies were included in this review.
RESULTS
Based on the review, NO intake provokes physiological and metabolic responses that could potentially boost exercise-related recovery. NO could improve recovery indicators related to strength, pain, inflammation, and muscle damage.
CONCLUSIONS
Despite the relative proven effectiveness of NO on recovery after aerobic and anaerobic efforts, based on the heterogeneity of the procedures (e.g., dosage, chronic vs. acute intake, participants' characteristics, variables and outcomes), it could be premature to suggest its extended use in sports.
Topics: Athletic Performance; Dietary Supplements; Exercise; Humans; Muscle Fatigue; Nitrates
PubMed: 36231323
DOI: 10.3390/ijerph191912021 -
PloS One 2016Rapid muscle fatigue during functional electrical stimulation (FES)-evoked muscle contractions in individuals with spinal cord injury (SCI) is a significant limitation... (Review)
Review
BACKGROUND
Rapid muscle fatigue during functional electrical stimulation (FES)-evoked muscle contractions in individuals with spinal cord injury (SCI) is a significant limitation to attaining health benefits of FES-exercise. Delaying the onset of muscle fatigue is often cited as an important goal linked to FES clinical efficacy. Although the basic concept of fatigue-resistance has a long history, recent advances in biomedical engineering, physiotherapy and clinical exercise science have achieved improved clinical benefits, especially for reducing muscle fatigue during FES-exercise. This review evaluated the methodological quality of strategies underlying muscle fatigue-resistance that have been used to optimize FES therapeutic approaches. The review also sought to synthesize the effectiveness of these strategies for persons with SCI in order to establish their functional impacts and clinical relevance.
METHODS
Published scientific literature pertaining to the reduction of FES-induced muscle fatigue was identified through searches of the following databases: Science Direct, Medline, IEEE Xplore, SpringerLink, PubMed and Nature, from the earliest returned record until June 2015. Titles and abstracts were screened to obtain 35 studies that met the inclusion criteria for this systematic review.
RESULTS
Following the evaluation of methodological quality (mean (SD), 50 (6) %) of the reviewed studies using the Downs and Black scale, the largest treatment effects reported to reduce muscle fatigue mainly investigated isometric contractions of limited functional and clinical relevance (n = 28). Some investigations (n = 13) lacked randomisation, while others were characterised by small sample sizes with low statistical power. Nevertheless, the clinical significance of emerging trends to improve fatigue-resistance during FES included (i) optimizing electrode positioning, (ii) fine-tuning of stimulation patterns and other FES parameters, (iii) adjustments to the mode and frequency of exercise training, and (iv) biofeedback-assisted FES-exercise to promote selective recruitment of fatigue-resistant motor units.
CONCLUSION
Although the need for further in-depth clinical trials (especially RCTs) was clearly warranted to establish external validity of outcomes, current evidence was sufficient to support the validity of certain techniques for rapid fatigue-reduction in order to promote FES therapy as an integral part of SCI rehabilitation. It is anticipated that this information will be valuable to clinicians and other allied health professionals administering FES as a treatment option in rehabilitation and aid the development of effective rehabilitation interventions.
Topics: Electric Stimulation Therapy; Exercise; Humans; Muscle Fatigue; Muscle, Skeletal; Spinal Cord Injuries
PubMed: 26859296
DOI: 10.1371/journal.pone.0149024