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Following further inclusion criteria, six studies were excluded because of the study design,[15, 23, 29-32] and four were excluded because of different stimulation positions (e.g. acupuncture points).[33-36] The reasons for exclusion are presented in Figure?1. Finally, eight RCTs were selected for this meta-analysis.[16-22, 37] The main characteristics of the eight RCTs are presented in Table?1. Eight RCTs involving a total of 156 patients (NMES vs control: 84 vs 72) were published between 2002 and 2012. The COPD patients were older (mean Depsipeptide clinical trial age ranged from 58.5 to 70 years) and predominantly male (male vs female: 115 vs 41). All RCTs reported quadriceps muscle strength, but only six provided data (mean?��?standard deviation or standard error).[16-21] Among these six studies, four RCTs reported isokinetic peak torque,[16, 17, 20, 21] one reported maximal voluntary contraction[19] and one reported strength score.[18] Three RCTs reported muscle fibre characteristics,[20, 22, 37] only the two studies that provided data were included in this meta-analysis.[22, 37] Three studies reported 6MWD;[19-21] however, only two[19, 21] were pooled because the study[20] BMS-907351 in vivo by Dal Corso reported on the same participants as the study[21] by Napolis. A total of three studies reported dyspnoea.[16, 19, 22] Two investigators (L.P. and Y.Z.G.) agreed on every item of the Jadad scores. The mean Jadad score was 3.1 (standard deviation?=?0.8). The risk-of-bias analysis showed that all RCTs did not adequately report randomization protocol, except for one RCT,[37] whereas only two RCTs[16, 21] described the method used to conceal the allocation (Fig.?2). Four RCTs that reported isokinetic peak torque, or employed isometric testing, were pooled in the meta-analysis.[16, 17, 19, 21] The aggregate results suggested that NMES was not associated with the significant improvement on the quadriceps strength (standardized mean difference 0.38; BML-190 95% CI: ?0.13�C0.89; P?=?0.14; P for heterogeneity?=?0.29; I2?=?20%) (Fig.?3). However, whether these data are indicative of a clinically meaningful difference is difficult to assess because of the lack of an MCID for muscle strength in COPD patients.[38] Exercise capacity was assessed by the 6MWD.[19, 21] The aggregate results suggested that NMES failed to increase the 6MWD (WMD 13.63?m; 95% CI: ?17.39�C44.65; P?=?0.39; P for heterogeneity?=?0.15; I2?=?51%) (Fig.?4). Subsequently, we failed to perform sensitivity analyses to explore the potential source of heterogeneity because only two RCTs were included. The mean changes of 6MWD were lower than the MCID (��26?m).[39] Three RCTs reported dyspnoea.[16, 19, 22] The aggregate results suggested that NMES significantly improved dyspnoea (WMD ?0.98 scores; 95% CI: ?1.42�C ?0.54; P?