Date Presented 3/31/2017
This presentation reports the findings from a survey of 63 occupational therapists who used electrical stimulation when treating patients with spinal cord injury. The study findings offer a snapshot of an emerging intervention area that is not yet standardized.
Primary Author and Speaker: Timothy Dionne
Contributing Authors: James Lenker
BACKGROUND: Previous case study research suggests that clinical application of neuromuscular electrical stimulation (ES) is based on anecdotal evidence and relatively weak data (Martin, Johnston, & Sadowsky, 2012). For patients with spinal cord injury (SCI), ES shows positive physiological effects; however, the combined effectiveness of ES and task-oriented repetitive reaching activities is unknown. The current study explored ES practice patterns among occupational therapists (OTs) working on SCI units. The goal was to identify the consistency and certainty with which OTs are applying ES in clinical settings so that intervention protocols for clinical use and future research can be defined.
DESIGN: The research design was descriptive. An online survey was created and disseminated in order to obtain a geographically dispersed sample. Using publicly available contact information, participants were recruited by telephone and email from SCI model systems and outpatient, inpatient, and day rehabilitation settings accredited by the Commission on Accreditation of Rehabilitation Facilities. Respondents provided formal consent and confirmed their eligibility to administer ES according to their state occupational therapy practice act.
METHOD: The survey tool was created by the research team, which obtained iterative feedback regarding content and clarity from four expert OTs. The final version was a 34-item tool that required approximately 10–20 min to complete. A total of 72 people completed the survey. Among these, 63 valid responses were descriptively analyzed to identify clinical practice patterns.
RESULTS: Respondents were from 18 states that reflect every region of the United States. The median occupational therapy practice experience of participants was 6 yr, and a majority of respondents (n = 35) reported that SCI patients comprised at least 50% of their caseload. Most had received ES training via staff in-service or continuing education courses that were at least 2 hr. Approximately 45% of respondents applied ES to one-half or more of their SCI caseload. The three most frequently reported clinical reasons for using ES were muscle strengthening, functional activities, and improvement of coordination. Among functional activities performed with ES, the three most frequently reported were grasp and release, reaching, and grip or pinch.
Just under one-half (n = 31) reported using ES on muscles with a manual muscle testing (MMT) score of 0. Just over half (51%) reported using a specific ES protocol, among which 37% based their protocols on anecdotal evidence and 27% based their protocols on research evidence. Common ES parameters were collected, resulting in a wide range of responses that were patient specific. Typical dosage (duration and length) varied, ranging from twice weekly at 15 min to five times per week at 60 min. There was a strong positive correlation (r = .668) between “confidence to initiate use” and “confidence to discontinue use” questions (p < .001) and a low correlation (r = .28) between years of experience and confidence in documenting goals related to ES use (p = .37).
CONCLUSION: Although some OTs reported confidence with their use of ES, only half used a specific protocol. Almost 50% reported use of ES on muscles with a MMT grade of 0, which could be a controversial approach, depending on whether one prioritizes use of ES for restoration or adaption purposes. This study offers a snapshot of an emerging intervention area that is not yet standardized. The data provide a starting point for future efficacy research involving patients with SCI.
References
Martin, R., Johnston, K., & Sadowsky, C. (2012). Neuromuscular electrical stimulation–assisted grasp training and restoration of function in the tetraplegic hand: A case series. American Journal of Occupational Therapy, 66, 471–477. https://doi.org/10.5014/ajot.2012.003004
Popovic, M., Kapadia, N., Zivanovic, V., Furlan, J., Cravern, B., & McGillivray, C. (2011). Functional electrical stimulation therapy versus only conventional rehabilitation for patients with subacute incomplete tetraplegia: A randomized clinical trial. Neurorehabilitation and Neural Repair, 25, 433–442. https://doi.org/10.1177/1545968310392924
