Optimal Method of Electrical Stimulation for the Treatment of Upper Limb Dysfunction After Stroke: A Systematic Review and Bayesian Network Meta-Analysis of Randomized Controlled Trials

Abstract

Background The obstacle of limb motor caused by stroke, especially the decline of motor function of upper limbs, can directly affect the activities of daily living of stroke patients with hemiplegia. Based on long-term clinical practice, the treatment effect of electrical stimulation methods for stroke limb dysfunction has been widely recognized and supported by authoritative guidelines and systematic reviews. However, which electrical stimulation method is the optimum in the treatment of stroke limb dysfunction is still a controversial issue. Objective In this paper, we adopted Network Meta-Analysis (NMA) to rank the priorities of various electrical stimulation methods, so as to select the optimal electrical stimulation method and discuss its rationality in guiding clinical practice. Methods We carried out a systematic review by searching a total of 6806 studies from 8 databases and 2 clinical trial registries, and finally screened out 34 studies for further investigation. Then, pairwise meta-analysis and Bayesian network meta-analysis were employed to evaluate the effectiveness and ranking of various interventions. The primary outcome measure was Fugl-Meyer Assessment Upper Extremity (FMA-UE), and the secondary outcome measures were Modified Barthel Index (MBI) and Modified Ashworth Scale (MAS). Finally, the risk of bias, publication bias and sensitivity of the Randomized Controlled Trials (RCTs) were evaluated. Results On the basis of comprehensive rehabilitation treatment (RT), the Functional Electrical Stimulation (FES) was superior than other electrical stimulation methods in improving both FMA-UE and MBI. Meanwhile, the results indicated that the Transcutaneous Electrical Acupoint Stimulation (TEAS) was the only electrical stimulation method that showed treatment advantages in reducing MAS. Conclusion The study showed that FES had the optimal overall rehabilitation effect on upper limb dysfunction of stroke patients based on the comprehensive RT, while the treatment effect of TEAS on upper limb spasticity after stroke was the most significant.

Effects of transcutaneous electrical acupoint stimulation on upper-limb impairment after stroke: A randomized, controlled, single-blind trial

“… 18 We also found a review article showing the positive effects of TEAS on upper limb functional recovery in stroke patients. 19 However, all included articles were published in Chinese, so the positive finding in this review article suffers from possible language bias. Also, most included RCTs did not accurately describe the stages of stroke, and the duration and treatment protocols of included trials varied significantly.…”

Ultrasound-Guided Median Nerve Electrical Stimulation to Promote Upper Limb Function Recovery after Stroke

“…Currently, the peripheral electrical stimulation includes the functional electrical stimulation (FES), the transcutaneous or neuromuscular electrical stimulation (TENS or NMES), and the transcutaneous electrical acupoint stimulation (TEAS) which combined the meridian theory of traditional Chinese medicine and repetitive sensory stimulation (RSS). These noninvasion peripheral electrical stimulation therapies can stimulate the senses, increase muscle power and movement function, and decrease limb spasticity through various stimulus currents and protocols [ 14 , 15 ]. Meanwhile, peripheral electrical stimulation-induced brain plasticity contributes to the long-term functional improvement [ 12 , 16 ].…”

“…ese noninvasion peripheral electrical stimulation therapies can stimulate the senses, increase muscle power and movement function, and decrease limb spasticity through various stimulus currents and protocols [14,15]. Meanwhile, peripheral electrical stimulation-induced brain plasticity contributes to the long-term functional improvement [12,16].…”

Intervention Effect of Rehabilitation Robotic Bed Under Machine Learning Combined With Intensive Motor Training on Stroke Patients With Hemiplegia

“…From the overall rehabilitation process after stroke, it is difficult to recover from hemiplegia of the lower limbs, which not only takes a long time but also costs a lot of money; the treatment effect is limited (Alawieh et al, 2018 ; Uwatoko et al, 2020 ; Tang et al, 2021 ). With the rapid development of modernization, informatization, and intelligent technology, high-performance rehabilitation robots have emerged.…”