Peripheral Electrical Stimulation on Motor Function and Activities of Daily Living After Stroke: A Systematic Review and Network Meta-analysis.

Objective: To compare the effects of different peripheral electrical stimulation protocols and current frequencies for poststroke motor function and activities of daily living.

Data Sources: Seven databases (PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, VIP Database, Wan-Fang Database, and Chinese Biomedical Database) were searched from inception to August 2024.

Study Selection: Two reviewers independently performed the literature selection. The included studies were randomized controlled trials providing peripheral electrical stimulation for patients with stroke.

Data Extraction: Two reviewers independently extracted data following a predeveloped Excel data collection sheet, including trial characteristics, intervention and comparator details, and outcome data. The risk of bias was evaluated by RoB2 tool, and the PRISMA guidelines were followed for reporting.

Data Synthesis: A total of 106 trials with 7513 participants were included. Meta-analysis showed that neuromuscular electrical stimulation (NMES) could be the optimal electrical stimulation protocol for improving the Fugl-Meyer Assessment score (standardized mean difference=1.67; 95% confidence interval [1.14-2.21]) and the modified Barthel Index score (standardized mean difference=1.73; 95% confidence interval [1.10-2.37]). The results showed that different frequencies of electrical stimulation ranked the top 5 in descending order for improving: (1) the Fugl-Meyer Assessment scores as follows: 20-30 Hz_NMES (surface under the cumulative ranking curve [SUCRA]=87.5%)>100 Hz_NMES (SUCRA=75.4%)>100 Hz_functional electrical stimulation (SUCRA=70.9%)>20/35 Hz_transcutaneous electrical acupoint stimulation (SUCRA=69.8%)>1-4 Hz_electrical acupuncture (SUCRA=69.6%) and (2) the modified Barthel Index scores as follows: 100 Hz_transcutaneous electrical nerve stimulation (SUCRA=77.3%)>5/15 Hz_NMES (SUCRA=68.3%)>100 Hz_transcutaneous electrical acupoint stimulation (SUCRA=65.6%)>35-50 Hz_functional electrical stimulation (SUCRA=64.8%)>1-4 Hz_electrical acupuncture (SUCRA=60.0%).

Conclusions: Adding electrical stimulation based on routine rehabilitation training can improve the motor dysfunction and activities of daily living of patients with stroke. Specifically, NMES with 20-30 Hz improves motor function best, whereas 100 Hz_transcutaneous electrical nerve stimulation improves activities of daily living best.