Examining the Evidence on Neuromuscular Electrical Stimulation for Swallowing: A Meta-analysis | Otolaryngology | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Robbins  SMHoughton  PEWoodbury  MGBrown  JL The therapeutic effect of functional and transcutaneous electric stimulation on improving gait speed in stroke patients: a meta-analysis.  Arch Phys Med Rehabil 2006;87853- 859PubMedGoogle Scholar
Ada  LFoongchomcheay  A Efficacy of electrical stimulation in preventing or reducing subluxation of the shoulder after stroke: a meta-analysis.  Aust J Physiother 2002;48257- 267PubMedGoogle Scholar
de Kroon  JRvan der Lee  JHIJzerman  MJLankhorst  GJ Therapeutic electrical stimulation to improve motor control and functional abilities of the upper extremity after stroke: a systematic review.  Clin Rehabil 2002;16350- 360PubMedGoogle Scholar
Akai  MHayashi  K Effect of electrical stimulation on musculoskeletal systems: a meta-analysis of controlled clinical trials.  Bioelectromagnetics 2002;23132- 143PubMedGoogle Scholar
Glanz  MKlawansky  SStason  WBerkey  CChalmers  TC Functional electrostimulation in poststroke rehabilitation: a meta-analysis of the randomized controlled trials.  Arch Phys Med Rehabil 1996;77549- 553PubMedGoogle Scholar
Dow  DEDennis  RGFaulkner  JA Electrical stimulation attenuates denervation and age-related atrophy in extensor digitorum longus muscles of old rats.  J Gerontol A Biol Sci Med Sci 2005;60416- 424PubMedGoogle Scholar
Al-Majed  AANeumann  CMBrushart  TMGordon  T Brief electrical stimulation promotes the speed and accuracy of motor axonal regeneration.  J Neurosci 2000;202602- 2608PubMedGoogle Scholar
Jancik  JDobsak  PEicher  JC  et al.  Increase in muscle strength after low frequency electrical stimulation in chronic heart failure.  Scr Med (Brno) 2003;76285- 290Google Scholar
Quittan  MWiesinger  GFSturm  B  et al.  Improvement of thigh muscles by neuromuscular electrical stimulation in patients with refractory heart failure: a single-blind, randomized, controlled trial.  Am J Phys Med Rehabil 2001;80206- 214PubMedGoogle Scholar
Paillard  TNoe  FEdeline  O Neuromuscular effects of superimposed and combined transcutaneous electrical stimulation with voluntary activity: a review.  Ann Readapt Med Phys 2005;48126- 137PubMedGoogle Scholar
Bélanger  MStein  RBWheeler  GDGordon  TLeduc  B Electrical stimulation: can it increase muscle strength and reverse osteopenia in spinal cord injured individuals?  Arch Phys Med Rehabil 2000;811090- 1098PubMedGoogle Scholar
Caggiano  EEmrey  TShirley  SCraik  RL Effects of electrical stimulation or voluntary contraction for strengthening quadriceps femoris muscles in an aged male population.  J Orthop Sports Phys Ther 1994;2022- 28PubMedGoogle Scholar
Freed  MLFreed  LChatburn  RLChristian  M Electrical stimulation for swallowing disorders caused by stroke.  Respir Care 2001;46466- 474PubMedGoogle Scholar
Leelamanit  VLimsakul  CGeater  A Synchronized electrical stimulation in treating pharyngeal dysphagia.  Laryngoscope 2002;1122204- 2210PubMedGoogle Scholar
Blumfeld  LHahn  JLePage  ALeonard  RBelafsky  P Transcutaneous electrical stimulation versus traditional dysphagia therapy: a nonconcurrent cohort study.  Otolaryngol Head Neck Surg 2006;135754- 757PubMedGoogle Scholar
Belafsky  PSpeirs  JHiss  SPostma  G The safety and efficacy of transcutaneous electrical stimulation in treating dysphagia: preliminary experience.  In: Program and abstracts of the Southern Section of the American Laryngological, Rhinological and Otological Society, Inc; January 8-11, 2004; Marco Island, Fla. Abstract 9
Carnaby-Mann  GCrary  M Neuromuscular electrical stimulation for treatment refractory dysphagia: a case series report [abstract].  Dysphagia200621287334 doi:10.1007/s00455-006-9044-5Google Scholar
Crary  MACarnaby-Mann  GDFaunce  A Electrical stimulation therapy for dysphagia: descriptive results of two surveys [published online ahead of print February 22, 2007].  Dysphagia doi:10.1007/s00455-006-9068-xGoogle Scholar
Langemore  SVandaele  DLogemann  J  et al NMES as a treatment for post-radiated head and neck cancer patients with dysphagia [abstract].  Dysphagia200621287334 doi:10.1007/s00455-006-9044-5Google Scholar
Portney  LWatkins  M Foundations of Clinical Research: Application to Clinical Practice. 2nd ed. Upper Saddle River, NJ: Prentice-Hall; 2000
Rosenthal  R Meta-analytic Procedures for Social Research.  Newbury Park, Calif: Sage; 1991
Maher  CGSherrington  CHerbert  RDMoseley  AMElkins  M Reliability of the PEDro scale for rating quality of randomized controlled trials.  Phys Ther 2003;83713- 721PubMedGoogle Scholar
Verhagen  APde Vet  HCde Bie  RA  et al.  The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus.  J Clin Epidemiol 1998;511235- 1241Google Scholar
van Tulder  MWCherkin  DCBerman  BLao  LKoes  BW The effectiveness of acupuncture in the management of acute and chronic low back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group.  Spine 1999;241113- 1123PubMedGoogle Scholar
Cohen  J Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Lawrence A Earlbaum Associates; 1988
DerSimonian  RLaird  N Meta-analysis in clinical trials.  Control Clin Trials 1986;7177- 188PubMedGoogle Scholar
Borenstein  MHedges  LHiggins  JRothstein  H Comprehensive Meta Analysis, Version 2.  Englewood, NJ: Biostat; 2005
Shaw  GSechtem  PSearl  JKeller  KTaib  ADowdy  E Transcutaneous neuromuscular electrical stimulation (VitalStim) curative therapy for severe dysphagia: myth or reality?  Ann Otol Rhinol Laryngol 2007;11636- 44PubMedGoogle Scholar
Original Article
June 2007

Examining the Evidence on Neuromuscular Electrical Stimulation for Swallowing: A Meta-analysis

Author Affiliations

Author Affiliations: Departments of Behavioral Science and Community Health (Dr Carnaby-Mann) and Communicative Disorders (Dr Crary), University of Florida Health Science Center, Gainesville.

Arch Otolaryngol Head Neck Surg. 2007;133(6):564-571. doi:10.1001/archotol.133.6.564

Objective  To evaluate the effect of transcutaneous neuromuscular electrical stimulation (NMES) on swallowing rehabilitation.

Data Sources  MEDLINE, PubMed, CINAHL, NML, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, doc online, Google, and EMBASE were searched for studies using NMES to treat dysphagia between January 1966 and August 2006.

Study Selection  Included were published or unpublished, English-language, clinical trials with a quantifiable dependent variable.

Data Extraction  Two researchers independently performed data extraction. A random-effects model was used to pool study results. The Cochran Q test was used to evaluate heterogeneity, and a funnel plot and Egger test were used to evaluate publication bias. A best-research synthesis using a methodological quality analysis was conducted.

Data Synthesis  A total of 81 studies were reviewed. Seven were accepted for analysis. A significant summary effect size was identified for the application of NMES for swallowing (Hedges g, 0.66; P<.001). Heterogeneity was significant for the combined trials (P<.10). When 2 outlier trials were removed, heterogeneity was no longer significant (P<.08). Publication bias was not identified on the funnel plot or Egger test (P = .25). Best-evidence synthesis showed indicative findings in favor of NMES for swallowing.

Conclusions  This preliminary meta-analysis revealed a small but significant summary effect size for transcutaneous NMES for swallowing. Because of the small number of studies and low methodological grading for these studies, caution should be taken in interpreting this finding. These results support the need for more rigorous research in this area.