Structural Preservation Without Functional Recovery: Physiotherapy Reflections on Early Neuromuscular Electrical Stimulation and Passive In-Bed Cycling.

Early physiotherapy interventions in critically ill patients aim to mitigate muscle wasting and functional decline. Lorenzoni et al. examined the effects of early neuromuscular electrical stimulation (NMES) combined with passive in-bed cycling on quadriceps morphology. While ultrasound measurements suggested structural preservation, functional outcomes remained unchanged. From a physiotherapy perspective, preserved thickness does not necessarily indicate preserved function, especially when interventions lack voluntary activation. This Commentary discusses the physiological and methodological limitations of interpreting passive interventions as exercise and emphasizes the need for integrated approaches combining NMES with active participation and multimodal assessment to better align structural preservation with meaningful functional recovery.