Electrotherapy in stroke rehabilitation can improve lower limb muscle characteristics: a systematic review and meta-analysis

Ruben Debeuf; Daan De Vlieger; Arne Defour; Karen Feyen; Stefania Guida; Lotte Cuypers; Mahyar Firouzi; An Tassenoy; Eva Swinnen; David Beckwée; Lynn Leemans

doi:10.1080/09638288.2024.2334444

Electrotherapy in stroke rehabilitation can improve lower limb muscle characteristics: a systematic review and meta-analysis

Disabil Rehabil. 2024 Apr 1:1-17. doi: 10.1080/09638288.2024.2334444. Online ahead of print.

Authors

Ruben Debeuf^{1

2

3}, Daan De Vlieger^{1

4}, Arne Defour^{1

4}, Karen Feyen¹, Stefania Guida^{1

5}, Lotte Cuypers¹, Mahyar Firouzi^{1

2

3

6}, An Tassenoy¹, Eva Swinnen^{1

2

3}, David Beckwée^{1

3

7}, Lynn Leemans¹

Affiliations

¹ Rehabilitation Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
² Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium.
³ Brussels Human Robotic Research Center (BruBotics), Vrije Universiteit Brussel, Brussels, Belgium.
⁴ Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
⁵ Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
⁶ Brain, Body and Cognition, Department of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium.
⁷ Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.

PMID: 38557249
DOI: 10.1080/09638288.2024.2334444

Abstract

Purpose: This review assesses the effect of electrotherapy (e.g. functional electrical stimulation (FES), motor and sensor therapeutic electrical stimulation (TES)) on muscle strength and skeletal muscle characteristics in individuals post-stroke compared to conventional or sham therapy.

Methods: A systematic literature search was conducted in MEDLINE, SCOPUS, and Web of Science, focusing on randomized controlled trials investigating the effect of electrotherapy. Data of interest was extracted from eligible studies, and risk of bias was assessed.

Results: In total, 23 studies (933 people post-stroke) were included, of which 17, which mainly focus on patients in a chronic stage of stroke recovery and the implementation of FES, were incorporated in the meta-analysis. A significant increase in muscle strength was found favoring electrotherapy over conventional therapy (SMD 0.63, 95% CI 0.34-0.91, I² = 37%, p = 0.07) and over sham therapy (SMD 0.44, 95% CI 0.20-0.68, I² = 38%, p = 0.08). Three studies investigated the effect on muscle thickness and found a significant increase in favor of electrostimulation when compared to conventional therapy (MD 0.11 cm, 95% CI 0.06-0.16, I² = 0%, p = 0.50).

Conclusion: Current evidence suggests electrotherapy in combination with physiotherapy has positive effects on lower limb muscle strength and skeletal muscle characteristics in patients recovering from stroke.

Keywords: Muscle strength; electrotherapy; meta-analysis; rehabilitation; stroke.

Plain language summary

As stroke is known to cause long term disability, the implementation of strengthening interventions in rehabilitation becomes an indispensable part to optimize recovery.Peripheral electrical stimulation might be a useful intervention since it has the potential to repetitively activate the sensory-motor system via electrical pulses to nerves and muscles of the paretic limb.Results of the meta-analysis indicate a beneficial effect of electrotherapy on muscle strength when compared to conventional and sham therapy, and muscle thickness when compared to conventional therapy.

Publication types

Review