Avaliação da eficácia da estimulação elétrica neuromuscular sobre a força muscular e a capacidade funcional em pacientes com insuficiência cardíaca: uma revisão sistemática com metanálise

Abstract

INTRODUCTION: Neuromuscular Electrical Stimulation (NMES), capable of inducing muscle contractions without voluntary effort by the individual, has been considered an alternative therapy to conventional rehabilitation (CR) of patients with Heart Failure (HF), with the objective of improving physical capacities and functional aspects of these patients. OBJECTIVES: To evaluate the effectiveness of NMES on muscle strength (MS) and functional capacity (FC) in patients with HF. MATERIALS AND METHODS: Systematic literature review of randomized controlled trials (RCTs) with meta-analysis, searching for articles published in the last 10 years in the CINAHL, EMBASE, LILACS, Physiotherapy Evidence Database (PEDro), PubMed, SciELO, Science Direct databases and Web of Science. Three independent reviewers analyzed the titles and abstracts and selected the RCTs, examining the effects of NMES versus exercise and / or NMES versus placebo on the FC and MS of patients with HF. The main reviewer evaluated the remaining eligibility criteria in the included studies. The Cochrane Risk of Bias Tool was used to assess methodological quality. The GRADE was used to assess the degree of recommendation of the evidence. Weighted average differences, percentage change (PV) and 95% CI were calculated. A meta-analysis was carried out to assess the effects of NMES on the variables CF, MS and quality of life (QOL). RESULTS: Ten articles met the study criteria. NMES resulted in a significant improvement in FC through the distance walked (SD) measured by the 6MWT (Z = 2.58; P = 0.010) and a significant improvement over the secondary QOL outcome (Z = 2.09; P = 0.04). However, no significant results were found on the MS outcome (Z = 1.05; P = 0.29). In general, high heterogeneity was found between the studies, limiting the reliability of the results. CONCLUSION: NMES can improve the FC of individuals with HF, in addition to the QOL, however it does not present any significant result on the improvement of MS in this population.