Background:. Re-educating the function of the trunk muscles is essential in successful rehabilitation of patients with stroke.  Functional Electrical Stimulation (FES) of the abdominal muscles is an intervention which may result in increasing the activation of these muscles and improving proximal stability and function.

Purpose: The aim of this study was to evaluate the effect of FES of the abdominals on the functional recovery in patients with stroke, when integrated into physiotherapy treatment.

Study Design and Participants: A single blinded randomised experimental study design was used.  Participants were between the ages of 18 to 85 years of age who presented with a first time ever stroke which occurred within the past three months and was confirmed by an MRI or CT scan and a neurologist.

Instrumentation: The Barthel Index (BI) and the Rivermead Motor Assessment were used to monitor changes in function and motor recovery, respectively. The EQ-5D was used to monitor the health related quality of life and the QALY (quality adjusted life year) tariff was calculated. The Physiological Cost Index (PCI) was measured at discharge and at and at the four week follow-up  for those participants able to walk either with the use of an aid or independently. Both channels of the FES Microstimulator were applied to the external oblique abdominal muscle on the affected side and were applied from the first day of inclusion to the study.

Data Analysis: Non-parametric statistics were used in most cases, as the sample size was small and the data were generally ordinal. The Mann-Whitney U was used to compare the two groups after the intervention on the ordinal outcome measures. The effect sizes were calculated for the primary outcome variables of BI, RMA Gross Function, the EQ-5DY tariff and the PCI.

Results: There were 19 participants enrolled in the study, nine in the control group and ten in the experimental group.  The change in BI scores from admission to follow-up (p=0.034), the EQ-5D usual activities at discharge (p=0.015) and the PCI at discharge (p=0.037) were found to be significantly improved in the experimental group.  The size of the effect of treatment on the difference in BI scores from admission to discharge was 0.75, a medium effect size. The treatment effect size on the EQ-5D tariff was 0.83 which indicates a large effect. The Mann Whitney U indicated a significantly lower ranking of PCI scores in the experimental group at discharge, indicating less effort on walking in this group.

Discussion and conclusion: FES appears feasible and might be beneficial in improving function in patients with stroke. Although the sample sizes were smaller than anticipated and resulted in non-significant probability values on testing of some variables, the effect size for most outcome parameters was medium to large. FES can be integrated, albeit cautiously, into physiotherapy management and the impact monitored on an on-going basis. As the results are promising but not conclusive, there is room for a large scale, multi-centre trial to further investigate the efficacy of this intervention.