Comparative effectiveness of neuromuscular electrical stimulation-based combination interventions for post-stroke lower limb rehabilitation: a systematic review and network meta-analysis
Abstract
Objective: This study aimed to comparatively evaluate the efficacy of different neuromuscular electrical stimulation (NMES)-based combination protocols for improving lower limb dysfunction in patients with stroke, in order to provide evidence-based support for clinical rehabilitation practice.
Methods: Randomized controlled trials (RCTs) investigating NMES-based combination interventions for lower limb dysfunction in patients with stroke published up to September 2, 2025 were systematically identified through searches of PubMed, Embase, the Cochrane Library, and Web of Science. The risk of bias of eligible studies was evaluated using the Cochrane Risk of Bias 2.0 (ROB 2.0) tool. Network meta-analysis (NMA) and subgroup analyses were conducted using R software (version 4.5.1) and Stata (version 15.0).
Results: In total, 37 RCTs were incorporated into the present NMA, involving 1,764 patients with stroke and encompassing nine distinct NMES-based combination intervention protocols. Regarding balance ability, core stability training (CST) combined with NMES (SMD = 0.99, 95% CrI: 0.33-1.67), gait training (GT) combined with NMES (SMD = 0.83, 95% CrI: 0.35-1.27), and NMES alone (SMD = 0.71, 95% CrI: 0.21-1.22) demonstrated significant therapeutic effects. CST+NMES (SUCRA = 76.02%) ranked highest among the NMES-based combined interventions for balance ability in patients with stroke. With respect to walking ability, no statistically significant differences were observed among the…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,764 participants or records.
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