Effect of different types of electrical stimulation on postural control and gait after stroke: A systematic review and meta-analysis

Abstract

Background: Electrical stimulation (ES) is commonly used in stroke rehabilitation to enhance balance and walking, but its effectiveness remains unclear.

Purpose: This systematic review evaluated randomized controlled trials (RCTs) on the effects of various ES types including transcranial direct current stimulation (tDCS), functional electrical stimulation (FES), transcutaneous electrical nerve stimulation (TENS), and neuromuscular electrical stimulation (NMES) on balance and gait in stroke patients.

Methods: A literature search was conducted in PubMed, Web of Science, and Scopus. RCTs comparing ES with sham or conventional therapies were included. Methodological quality was assessed Via the PEDro scale. Meta analyses were performed for the Berg Balance Scale (BBS), Timed Up and Go (TUG) test and Trunk Impairment Scale (TIS), with qualitative analysis for other outcomes.

Results: A meta-analysis of 20 randomized controlled trials (1,366 participants) examined tDCS, FES, TENS, and NMES effects on balance using BBS, TUG, and TIS. Meta-regression analyses within the FES subgroup revealed that stimulation intensity, frequency, and electrode location did not significantly influence treatment outcomes (all P > 0.05). However, outcome type was a significant moderator (QM = 13.59, P = 0.0011), accounting for approximately 56% of between-study heterogeneity. FES showed larger effect sizes for balance outcomes (BBS) compared to mobility (TUG) or trunk control (TIS) measures. Balance improvements were greatest in the acute stroke phase, suggesting that timing may influence ES effectiveness.

Conclusion: Electrical stimulation significantly improves balance and trunk control in stroke survivors with consistent effects across studies, however functional mobility benefits remain unclear due to high degree of study variability. Early intervention during acute stroke phases appears most effective, supporting the integration of electrical stimulation into post stroke rehabilitation protocols.

Keywords: electrical stimulation; gait; meta review; postural control; stroke.