Effect of EMG-triggered neuromuscular electrical stimulation with bilateral arm training on hemiplegic shoulder pain and arm function after stroke: a randomized controlled trial.

The trial had no placebo stimulation control and only a 1-month follow-up, so longer-term effects and nonspecific effects remain uncertain. Both groups received bilateral arm training, and the study did not compare EMG-triggered NMES alone, TENS alone, or bilateral arm training alone, so the contribution of any single component cannot be separated. Participants were at least 3 months after stroke, and mean time since stroke was 31.89 months in the EMG group and 33.47 months in the TENS group, so findings may not apply to acute stroke. Aphasia and severe cognitive deficits were excluded, and participants needed Mini-Mental State Examination score at least 24, so results may not apply to people with communication or cognitive impairment. The analysis included 38 participants, and subgroup analyses by shoulder subluxation used smaller numbers, such as 9 with subluxation in the EMG group and 8 in the TENS group, so subgroup conclusions are limited. The paper reports significant differences for pain during movement and worst pain, but not for pain at rest or pain interference, so the positive results are outcome-specific.

Funded by Ministry of Science and Technology, Taiwan; Chang Gung Memorial Hospital, Linkou; and Healthy Aging Research Center at Chang Gung University. The supplied text does not state other author conflicts of interest.

Do not conclude that EMG-triggered NMES alone is the active treatment. Both groups received bilateral arm training, and the trial did not compare stimulation with bilateral arm training alone, so it cannot show how much of the benefit came from the stimulation or the training.