Systematic review of the effects of neuromuscular electrical stimulation in post-coronavirus disease.
Nathali Carvajal-Tello, Alejandro Segura-Ordóñez, Harry García-Muñoz and 5 others
PMID 40950566WHAT IT FOUND
NMES was associated with improved muscle strength and walking in post-COVID-19 patients, but the evidence rests on four small studies with different measures, so no single dosing protocol is supported.
Key findings
01Across the four included studies, NMES was associated with improved muscle strength (MRC median rose from 18.8 to 52.4 in one study; surface EMG improved significantly by day nine, p = 0.04) and reduced sedentary time (200.8 min less, p < 0.02) with more walking (22.2 min more, p < 0.03).
02The NMES protocols varied widely: intervention lasted 9 to 30 days with sessions of 30 to 60 minutes, frequency ranged from 20 to 121 Hz, pulse width from 350 to 1400 µs, and intensity from 20 to 250 mA.
03Only four studies met the inclusion criteria. Because each used different outcome measures, the authors could not compare functional results across studies, and the varying dosing parameters prevented specific prescription recommendations.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only four studies were included, with a combined total of 72 participants, so the evidence base is very small. The studies used different outcome measures (MRC, surface EMG, grip strength, PFIT-s, DEMMI, SOMS, Morse Fall Scale, SF-36), making it impossible to pool results or compare functional outcomes across studies. NMES dosing parameters varied widely across studies (frequency 20 to 121 Hz, pulse width 350 to 1400 µs, intensity 20 to 250 mA, duration 9 to 30 days), so no specific protocol can be recommended. Most studies lacked blinding of participants and assessors, and allocation concealment was not reported in two of the three controlled trials. One of the four studies (Righetti) had no control group at all, and another (Ozyemisci Taskiran) found no significant differences between groups.
Declared interests
Funded by the Dirección General de Investigaciones of Universidad Santiago de Cali (reference DGI-01-2025). No industry funding or conflicts of interest were declared.
The easy way to misread this
Do not read this as a recommendation for a specific NMES protocol in post-COVID-19 care. The four included studies used different frequencies, pulse widths, intensities, and durations, and only one had a true placebo control. The authors state that the varying parameters prevent specific dosing recommendations.
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