The efficacy of contralaterally controlled functional electrical stimulation compared to conventional neuromuscular electrical stimulation for recovery of limb function following a stroke: a systematic review and meta-analysis.

ABSTRACT

Introduction: Limb paresis following a stroke is a common sequela that can impact patients' quality of life. Many rehabilitation strategies targeting the restoration of motor function exist. This systematic review and meta-analysis aim to evaluate the effects of contralaterally controlled functional electrical stimulation (CCFES) as a modality for limb rehabilitation. Unlike conventional neuromuscular electrical simulation (NMES), the contra-laterality in CCFES is achieved by two methods a bend angle sensor or an electromyographic bridge (EMGB) method, both of which targets signals from the unaffected limb. Method: This review study was performed following the preferred reporting item for systematic review and meta-analysis (PRISMA) guidelines. Records that met the inclusion criteria were extracted from the following databases Medline, Embase, and Cochrane Register of Controlled Trials (CENTRAL). Additional articles were also retrieved from clinicaltrials.gov and China/Asia on Demand (CAOD). Only randomized controlled studies (RCTs) were included. Results: Sixteen RCTs met the inclusion criteria, and 14 of which were included in the quantitative analysis (meta-analysis). The results of the analysis show that when compared to conventional NMES, CCFES displayed a better improvement in the upper extremity Fugl-Meyer assessment (UEFMA) (SMD = 0.41, 95% CI 0.21, 0.62, p-value <0.0001, I2 = 15%, GRADE moderate), box and blocks test (BBT) (SMD = 0.48, 95% CI 0.10, 0.86, p-value = 0.01, I2 = 0%, GRADE very low), modified Barthel index (mBI) (SMD = 0.44, 95% CI 0.16, 0.71, p-value = 0.002, I2 = 0%, GRADE moderate), active range of motion (AROM) (SMD = 0.61, 95% CI 0.29, 0.94, p-value = 0.0002, I2 = 23%, GRADE moderate), and surface electromyography (sEMG) scores (SMD = 0.52, 95% CI 0.14, 0.90, p-value = 0.008, I2 = 0%, GRADE low). The results of the subgroup analysis for the type of sensor used in CCFES shows that an EMGB (SMD = 0.58, 95% CI 0.33, 0.84, p-value <0.00001, I2 = 7%) is more effective than a bend angle sensor (SMD = 0.17, 95% CI -0.12, 0.45, p-value = 0.25, I2 = 0%). Conclusion: The results of this study provide strong evidence that shows CCFES being a better electrical stimulation modality compared to conventional NMES. This could be explained by the fact that CCFES is bilateral in nature which offers a platform for better neuroplasticity following a stroke. There is still a need for high-quality studies with a standardized approach comparing CCFES to other treatment modalities. Systematic review registration https//www.crd.york.ac.uk/prospero/display_record.php?RecordID=342670, identifier CRD42022342670.