Network meta-analysis of different electrical stimulation therapies for lower limb functional rehabilitation in...

Electrical stimulation is widely applied in the rehabilitation of post-stroke lower limb dysfunction; however, its comparative efficacy and safety across different modalities remain unclear. Substantial heterogeneity among electrical stimulation techniques limits evidence-based clinical decision-making, highlighting the need for a comprehensive comparative evaluation.

A comprehensive literature search was conducted across seven databases (CNKI, Wanfang, VIP, PubMed, Embase, Web of Science, and the Cochrane Library) from inception to June 2025. Randomized controlled trials evaluating electrical stimulation interventions for post-stroke lower limb dysfunction were included. Methodological quality was assessed using the Cochrane Risk of Bias 2.0 tool. Network meta-analysis was performed using Stata 18.0 and R 4.3.2, and treatment rankings were estimated based on surface under the cumulative ranking curve (SUCRA) probabilities.

A total of 81 randomized controlled trials involving 6,147 patients and 24 intervention strategies were included. Network meta-analysis demonstrated that: (1) For lower limb motor function (Fugl-Meyer Assessment, lower extremity), electromyography-triggered functional electrical stimulation combined with conventional functional electrical stimulation ranked highest (SUCRA = 89.0%), whereas conventional therapy ranked lowest (SUCRA = 4.3%). (2) For balance ability (Berg Balance Scale), multi-channel functional electrical stimulation showed the greatest efficacy (SUCRA = 85.6%), compared with conventional therapy (SUCRA = 4.2%). (3) For activities of daily living (Modified Barthel Index), closed-loop neuromuscular electrical stimulation was most effective (SUCRA = 71.9%), while conventional therapy ranked lowest (SUCRA = 3.0%). (4) For walking speed (10-Meter Walk Test), low-frequency electrical stimulation demonstrated superior efficacy (SUCRA = 66.2%) compared with neuromuscular electrical stimulation (SUCRA = 35.6%). (5) For functional ambulation (Functional Ambulation Category), transcranial direct current stimulation achieved the highest ranking (SUCRA = 99.7%).

Different electrical stimulation modalities provide domain-specific benefits in post-stroke lower limb rehabilitation. Tailored selection of stimulation techniques may optimize functional recovery. Nevertheless, the overall evidence remains limited, and further large-scale, high-quality randomized trials are required to confirm these findings and elucidate underlying neuroregulatory mechanisms.

PROSPERO, identifier CRD420251087696.