Akar 2017.

Methods	Randomised controlled trial
Participants	30 participants were enrolled. All participants had been admitted to the ICU with respiratory failure. 10 were allocated to an intervention group that received NMES + exercise training (4 men, mean age = 70 (SD 12) yr). 10 were allocated to a control group that received exercise training only (5 men, mean age = 68 (SD 18) yr). 10 were allocated to a control group that received NMES only (these participants were not included in this review) (6 men, mean age = 63 (SD 7) yr).
Interventions	All groups received positioning, postural drainage, bronchial hygiene techniques, tracheal aspiration as necessary and nutritional and psychological support. Intervention: bilateral electrical stimulation of deltoids and quadriceps using biphasic symmetric square waves with an amplitude of 20‐25 mA (determined by participant tolerance), at a frequency of 50 Hz for 6 s contractions, 5 days per week (total of 20 sessions). Both visible and palpable muscle contractions were obtained. This group also received active exercise that comprised active joint range of motion exercise for upper and lower limbs. Participants who could not manage active exercise received active‐assisted or passive range of motion exercise. Control: active exercise that comprised active joint range of motion exercise for upper and lower limbs. Participants who could not manage active exercise received active‐assisted or passive range of motion exercise.
Outcomes	Muscle strength measured via manual muscle testing Functional outcomes recorded (e.g. participant's capacity to sit up in bed, move from bed) Heart rate and respiratory rate before and after training programme Length of stay in ICU and weaning success Biomarkers (via venous blood samples) of CRP, IL‐6, IL‐8, IL‐10 and TNF‐alpha
Notes	Funding support not stated
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Quote: "...were randomized during the early intubation period." Details pertaining to the development of the randomisation sequence were not reported.
Allocation concealment (selection bias)	Low risk	Quote: "...were randomized during the early intubation period (the first workday following hospitalisation) in a blinded fashion."
Blinding of participants and personnel (performance bias) All outcomes	High risk	No sham stimulation
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Quote: "Patients' pre‐ and post‐PR lower extremity and upper extremity muscle strength were scored manually by a single, experienced physician blinded to randomization with a scale of 5." No mention of blinding for other outcomes. This was unlikely to have affected outcomes related to blood biomarkers, but may have affected measures of functional outcomes, length of stay and weaning success.
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Insufficient details on attrition to comment on whether this was a source of bias.
Selective reporting (reporting bias)	Unclear risk	No protocol available
Other bias	Low risk	Study appeared free from other sources of bias.