Evaluating the Effect of Functional Electrical Stimulation Used for Foot Drop on Aspects of Health-Related Quality of Life in People with Multiple Sclerosis: A Systematic Review

Abstract

Background: Multiple sclerosis (MS) is a common degenerative neurologic condition resulting in walking difficulties. Foot drop is a common walking impairment in MS that can affect health-related quality of life (HRQOL). Functional electrical stimulation (FES) can improve walking in people with MS, but its effect on HRQOL is not well established. This review investigated the effect of FES used for foot drop on HRQOL in adults with MS.

Methods: A systematic search was performed using CINAHL, MEDLINE, Cochrane Library, PubMed, and PEDro online databases. Inclusion and exclusion criteria were applied to select eligible studies. Data were extracted, and two reviewers independently rated the quality of the studies using the Effective Public Health Practice Project assessment tool.

Results: Eight studies were eligible for review; seven were of moderate-to-strong methodological quality and one was weak. Seven studies demonstrated significant positive effects of FES on different aspects of HRQOL as measured by the 29-item Multiple Sclerosis Impact Scale, 36-item Short Form Health Status Survey, Canadian Occupational Performance Measure, and Psychosocial Impact of Assistive Devices Scale.

Conclusions: This review provides preliminary evidence that FES has a positive effect on aspects of HRQOL in people with MS; however, the variety of HRQOL outcomes used makes it difficult to determine definitive conclusions. Future larger-scale randomized studies with long-term follow-up are recommended to better understand the effect of FES on HRQOL. This will inform prescribing decisions and support compliance with FES over the longer-term.

Keywords: Functional electrical stimulation; Gait disorders; Health outcomes; Multiple sclerosis (MS); Quality of life.

Figure.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Diagram Inclusion criteria were as follows: English language, published in 2010 or later, any study design (empirical or observational), participants older than 18 years diagnosed as having multiple sclerosis (MS) (any presentation) or mixed neurologic conditions where MS data are reported separately, functional electrical stimulation (FES) used for foot drop as an intervention (surface or implanted), participants presenting with foot drop (bilateral or unilateral), at least one health-related quality of life–related outcome measure (29-item Multiple Sclerosis Impact Scale, 36-item Short Form Health Survey, Canadian Occupational Performance Measure, Psychosocial Impact of Assistive Devices Scale) used to assess effect of FES. Exclusion criteria were as follows: nonadult population, non-MS population, FES not used as an intervention, and systematic reviews.