SYSTEMATIC REVIEW article
Front. Neurol.
Sec. Neurorehabilitation
Comparative Effects of Six Rehabilitation Therapies on Lower Limb Function and Gait Function in Stroke Patients: A Network Meta-Analysis of 33 RCTs
Shuxin Zhang 1,2
Hongying Zhang 3
Zhaobin Miao 4
Jia Han 1
1. Shanghai University of Sport, Shanghai, China
2. Shanghai Sanda University, shanghai, China
3. Shanghai Second People's Hospital, Shanghai, China
4. Shanghai Yangpu District Kongjiang Hospital, Shanghai, China
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Abstract
Objective: This study aims to systematically compare the relative efficacy of six non-invasive rehabilitation interventions—Standardized Rehabilitation (SR), Aerobic Rehabilitation (AR), Resistance Training Rehabilitation (RTR), Intelligent Rehabilitation (IR), Traditional Chinese Rehabilitation (TCR), and Neuromodulation Rehabilitation (NR)—in improving lower limb function and gait function in stroke patients using a network meta-analysis approach. It also ranks the efficacy of each intervention. Methods: We systematically searched five databases—PubMed, Embase, EBSCO, Web of Science, and Scopus—for randomized controlled trials (RCTs) published from January 2003 to November 2025. Two researchers independently screened studies, extracted data, and assessed risk of bias. Stata 18.0 software was used for statistical analysis. Standardized mean differences (SMDs) and their 95% confidence intervals (CIs) were calculated. Probabilistic ranking of intervention efficacy was performed using the cumulative ordered ranking curve area (SUCRA) value. Results: A total of 33 RCTs were included. Network meta-analysis revealed: 1) For lower limb function improvement (using the Fugl-Meyer lower limb score as the core indicator), the efficacy ranking was IR (SUCRA=75.7) > AR (60.7) > RTR (53.1) > SR (10.5). Smart rehabilitation had the highest probability (46.7%) of being the optimal approach. 2) For gait function improvement (core measures: walking speed, 6-minute walk test), the efficacy ranking was NR (SUCRA=82.2) > IR (71.6) > AR (50.8) > RTR (38.8) > TCR (35.7) > SR (20.9). Neuromodulation rehabilitation had the highest probability of being the optimal solution (36.5%). Direct and indirect comparison results were largely consistent, with funnel plots showing no significant publication bias. Conclusion: Based on existing evidence, intelligent rehabilitation may offer relative advantages in improving lower limb function in stroke patients, while neuromodulation rehabilitation demonstrates greater potential for enhancing gait function. Standardized rehabilitation, as a conventional baseline approach, demonstrated relatively weaker effects. The ranking results from this study provide evidence-based guidance for clinicians selecting individualized rehabilitation programs targeting different functional goals. Future high-quality research is needed to validate and refine intervention recommendations for different disease stages.
Summary
Keywords
gait function, Lower limb function, Network meta-analysis, Rehabilitation Intervention Comparison, stroke rehabilitation
Received
10 December 2025
Accepted
06 February 2026
Copyright
© 2026 Zhang, Zhang, Miao and Han. 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: Zhaobin Miao; Jia Han
Disclaimer
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