Functional Electrical Stimulation Cycling for Balance Rehabilitation in Stroke Survivors: A Systematic Review and...

This review aims to examine the impacts of functional electrical stimulation (FES) cycling on balance post-stroke, identify the optimal treatment protocol, if possible, and provide future suggestions for research and clinical practice.

"PubMed, Scopus, EMBASE, CINAHL, MEDLINE, and Web of Science" databases were screened until August 2025. Randomized controlled trials that included stroke survivors who underwent FES cycling, compared with active or passive treatments, and assessed balance impairments were included in this review. Meta-analysis was carried out using "Comprehensive Meta-Analysis Version 4." The quality of the eligible studies was estimated using the PEDro scale.

Nine studies met our criteria. In total, 285 stroke patients (mean age 62.46 years; 59% male) were included in this review. The studies ranged from 6 to 9 on the PEDro scale, with a median of 8. The meta-analysis showed that FES cycling was inferior to control interventions for improving balance poststroke. For the Trunk control test, a non-significant improvement was observed (SMD = 0.250, 95% CI: -0.260 to 0.761, p = 0.336, I² = 41%). For the Berg Balance Scale, meta-analysis revealed a statistically significant pooled effect favoring control interventions over FES cycling (SMD = -0.52, 95% CI -0.97 to -0.08). Non-meta-analysis outcomes indicated some improvements in balance parameters, but overall findings remain inconclusive.

Current evidence does not support a beneficial effect of FES cycling on balance poststroke. While commonly used stimulation parameters are physiologically justified, evidence is insufficient to determine optimal FES cycling parameters for improving balance outcomes post-stroke. FES cycling should be tailored to patient characteristics and baseline impairments. Further studies of larger sample sizes are needed.