As the population ages and surgical advances lead to more complex surgeries for frail patients, the need for appropriate post-operative rehabilitation grows. Effective rehabilitation is a challenging prospect in the face of escalating healthcare expenses and limited resources. The use of Neuromuscular Electrical Stimulation (NMES) devices has shown to be beneficial in accelerating recovery after orthopaedic surgery, stroke and intensive care stay. NMES uses electrical impulses to generate involuntary contractions of lower limb muscle groups. This allows for continued muscle training without the need for therapists. The purpose of this study is to look at the acceptability and safety of NMES as an adjunct for rehabilitation after vascular and general surgery and monitor the effects of NMES in postoperative recovery.

This is a single-centre single blind pilot randomised controlled trial. Patients above the age of 18 with a Rockwood frailty score of ≥3 undergoing vascular or general surgery were eligible for recruitment. Eligible patients underwent baseline assessment before intended surgery and were randomised to either active or sham device. Participants were familiarised with the device when deemed medically stable by their surgical team. Assessments were carried out at this point and again when the patient was declared medically fit. The final assessment was carried out on the day of discharge (Image 1). The primary outcomes were the safety of the device and its acceptability as assessed by semi-structural questionnaires on discharge. Secondary outcomes included length of stay, time with inpatient physiotherapy, activity levels, validated independence (Barthels Index) and quality of life measures (EQ-5D-5L).

A total of 103 patients (73% male) were recruited to the study. Participants were randomised to active device(n=55) or sham(n=48). 5 participants withdrew (2 in the active arm) from the trial citing unwillingness to participate in a trial during their post-operative recovery. Three other participants were withdrawn as they had their surgery cancelled. The final analysis was carried out on 95 patients (52 in active group and 43 in sham group). The baseline characteristics of the two groups were similar (Table 1). Mean age of the study participants was 63.35 (±12.75) years, and the mean Rockwood frailty score was 3.57 (±0.75). There were no safety issues in either group. 74.4% of participants in the active group found the device acceptable and 72.8% of the participants were confident in using the device. Only 14.8% of participants found the effort required to use the device to be significant. The average length of stay was similar in both groups (10.7 days in the active group and 9.0 in the sham group, p=0.353). Patients had an improved Barthel Index score in the active group compared to the sham group (18.12 vs 17.56), but this did not reach the level of significance (p=0.236). Quality of life as measured by the EQ- 5D-5L index value was also improved in the active group (0.55 vs 0.49), but this did not reach the level of significance (p=0.353).

NMES devices are safe and acceptable as an adjunct for rehabilitation in patients undergoing general and vascular surgeries. In light of this successful feasibility study, further research is warranted to investigate the impact of NMES in decreasing length of in hospital stay and patient quality of life.