ORIGINAL RESEARCH article
Front. Neurol.
Sec. Stroke
This article is part of the Research TopicPost-stroke Epilepsy: Risks, Prognosis, and PreventionView all 6 articles
Network Meta-Analysis of Different Electrical Stimulation Therapies for Lower Limb Functional Rehabilitation in Stroke Patients
Provisionally accepted
- The First Affiliated Hospital of Hunan College of Traditional Chinese Medicine, Zhuzhou, China
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Despite extensive clinical application of electrical stimulation for post-stroke lower limb dysfunction, systematic evaluation of its therapeutic efficacy and safety profile remains lacking, thereby precluding informed clinical decision-making in practice.The efficacy heterogeneity of diverse electrical stimulation modalities for post-stroke lower limb dysfunction necessitates comparative efficacy evaluation to guide clinical practice. We aimed to assess the therapeutic efficacy profiles of electrical stimulation interventions through this network meta-analysis. Comprehensive literature retrieval spanned seven databases (CNKI, Wanfang, VIP, PubMed, Embase, Web of Science, Cochrane Library) from inception to June 2025. Methodological quality was evaluated using Cochrane Risk of Bias 2.0, with analytical procedures in Stata 18.0 and R 4.3.2 generating surface under the cumulative ranking curve (SUCRA) probabilities. This analysis incorporated 81 randomized controlled trials involving 6,147 patients, evaluating 24 interventions. Network meta-analysis revealed: For Fugl-Meyer Lower Extremity improvement: Electromyography-Triggered FES combined with conventional functional electrical stimulation demonstrated optimal efficacy (SUCRA=89.0%) vs conventional therapy (SUCRA=4.3%). For Berg Balance Scale: Multi-channel functional electrical stimulation was most effective (SUCRA=85.6%) vs conventional therapy (SUCRA=4.2%). For Modified Barthel Index: Closed-loop neuromuscular electrical stimulation ranked highest (SUCRA=71.9%) vs conventional therapy (SUCRA=3.0%). For 10-Meter Walk Test: Low-frequency electrical stimulation showed superior efficacy (SUCRA=66.2%) vs neuromuscular electrical stimulation (SUCRA=35.6%). For Functional Ambulation Category: Transcranial direct current stimulation achieved dominant efficacy (SUCRA=99.7%).The findings demonstrate that specific electrical stimulation modalities yield dimension-specific improvements: combined Electromyography-Triggered and conventional functional electrical stimulation enhances motor function, Multi-channel FES improves balance, closed-loop neuromuscular stimulation augments daily living capacity, low-frequency stimulation increases walking speed, and transcranial direct current stimulation optimizes ambulatory capacity. However, the evidence base remains inadequate, warranting validation through large-scale randomized trials and neuroregulatory mechanistic investigations. Systematic Review Registration PROSPERO, identifier CRD420251087696.
Keywords: Electrical Stimulation, Lower limb function, Network meta-analysis, randomized controlled trials, Stroke
Received: 09 Aug 2025; Accepted: 27 Nov 2025.
Copyright: © 2025 Liu, Zeng, Peng, Wen, Liu, Tang and Su. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Huaxin Su
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