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Comparative Effectiveness Review of Functional Electrical Stimulation (FES) for Upper Extremity Rehabilitation Post Stroke

May 9, 2019

Health Problem: In the United States, stroke afflicts 795,000 individuals each year, with 610,000 being a first stroke and 185,000 being recurrent stroke. Stroke causes 140,000 deaths annually. It is estimated that 29% to 75% of stroke survivors experience upper extremity impairments and stroke reduces mobility in more than 50% of survivors age 65 years and older.

Technology Description: Functional electrical stimulation (FES) devices apply short-duration electrical impulses to peripheral nerves that control paretic (or weakened) muscles to induce muscle contractions of sufficient strength and coordination to allow function or accomplishment of functional tasks. FES is used as an adjunct to conventional occupational and physical therapy (COPT). While FES devices may be used during the performance of functional tasks or activities of daily living, the ultimate goal of FES is to promote the recovery of stroke-induced motor dysfunction, thereby increasing independence and improving quality of life (QOL). FES is sometimes referred to as neuromuscular electrical stimulation, a broader term that includes peripheral motor nerve stimulation.

Controversy: Although positive reports suggest FES improves upper limb motor function post stroke, some studies have suggested that FES may not provide additional benefit beyond COPT alone. In addition, well-designed studies reporting the effectiveness and safety of long-term use of FES are needed and optimal parameters (e.g., FES device and settings, specific muscles stimulated, schedule and duration of FES therapy) have not yet been identified.

Key Questions:

  • Does FES improve physical status, function, disability, and QOL in patients with upper limb impairment following stroke?
  • Does the addition of FES to COPT improve outcomes compared with COPT alone?
  • Is FES safe?
  • Have specific patient selection criteria for FES been established?