Optimization of electrical stimulation for the treatment of lower limb dysfunction after stroke: A systematic review and Bayesian network meta-analysis of randomized controlled trials

• Published in: PloS one Vol. 18; no. 5; p. e0285523
• Main Authors: Fang, Yu, Li, Jiang, Liu, Shanyu, Wang, Yan, Li, Jiaming, Yang, Dongdong, Wang, Qiaoling
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 11.05.2023; Public Library of Science (PLoS)
• Subjects: Activities of Daily Living; Bayes Theorem; Bayesian analysis; Bayesian statistical decision theory; Biology and Life Sciences; Care and treatment; Clinical medicine; Clinical trials; Complications and side effects; Computer and Information Sciences; Direct current; Electrical stimulation of the brain; Electrical stimuli; ESB; Evaluation; Health risks; Humans; Lower Extremity; Medicine and Health Sciences; Meta-analysis; Methods; Muscle strength; Neuromuscular electrical stimulation; Occupational therapy; Optimization; Physical Sciences; Randomized Controlled Trials as Topic; Rehabilitation; Research and Analysis Methods; Risk assessment; Spasticity; Stimulation; Stroke; Stroke (Disease); Stroke - therapy; Stroke Rehabilitation - methods; Systematic review; Transcranial Direct Current Stimulation - methods; Transcutaneous electrical nerve stimulation-TENS; Walking; China; Morocco
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0285523

To compare the treatment effect of five electrical stimulation methods commonly used in the treatment of stroke patients with lower limb dysfunction. We implemented a systematic search of 3915 studies published up to January 2023 from eight databases and two clinical trial registries. First, two independent reviewers critically evaluated trial eligibility according to the inclusion and exclusion criteria. Next, they selected and extracted data. Then, they assessed the risk of bias. Pairwise meta-analysis and Bayesian network meta-analysis were conducted to estimate the effectiveness and ranking of the five electrical stimulation methods. A total of 33 trials with a final total of 2246 subjects were included in the analysis. By combining the comprehensive Rehabilitation Treatment (RT), the treatment effects of using five electrical stimulation methods were surperior to those of using RT only. In the meantime, RT+transcranial Direct Current Stimulation(tDCS) and RT+Functional Electrical Stimulation(FES) could be the optimal electric stimulation schemes for restoring lower limb motor function(SMD 8.35, 95%CI [3.05, 13.34]/ SMD 5.64, 95%CI [3.68, 7.56]), improving balance (SMD 9.80, 95%CI [0.67, 20.93]/ SMD 6.54, 95%CI [3.85, 10.95]) and activities of daily living(SMD 18.95, 95%CI [0.401, 36.9]/ SMD 15.47, 95%CI [7.89, 22.75]), and the treatment effects would be even better using RT+FES+tDCS combination. tDCS and FES superior to other electrical stimulation methods based on RT in the treatment of lower limb dysfunction after stroke.