The effects of cycling with and without functional electrical stimulation on lower limb dysfunction in patients post-stroke: A systematic review with meta-analysis

Article type: Review Article

Authors: Shariat, Ardalan^{a; *} | Najafabadi, Mahboubeh Ghayour^b | Ansari, Noureddin Nakhostin^{a; c} | Cleland, Joshua A.^d | Singh, Maria A. Fiatarone^{e; f} | Memari, Amir-Hossein^a | Honarpishe, Roshanak^c | Hakakzadeh, Azadeh^a | Ghaffari, Maryam Selk^a | Naghdi, Soofia^{a; c}

Affiliations: [a] Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran | [b] Department of Motor Behavior, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran | [c] Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran | [d] Franklin Pierce University, Manchester, NH, USA | [e] University of Sydney, Faculty of Health Sciences, Sydney, Australia | [f] Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University and Hebrew SeniorLife, Boston, MA, USA

Correspondence: [*] Address for correspondence: Ardalan Shariat (Post-doc Fellow of Neurorehabilitation), Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. E-mail: [email protected].

Abstract: BACKGROUND:One of the leading causes of disability in the world with enormous economic burden is stroke. OBJECTIVE:To quantify the effectiveness of different protocols of cycling with/without functional electrical stimulation on functional mobility after stroke. METHODS:Multiple databases were searched till 2018. Data extraction was performed using a pre-determined data collection form. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation. RESULTS:A total of 14 trials satisfied eligibility criteria and were included. Cycling had a positive effect on the 6-meter walking test performance (SMD, 0.41; 95% CI, 0.11 –0.71; I2 = 0% ) compared with no or placebo intervention (control). Compared with control, cycling had a positive effect on 10-meter walking speed (SMD, 0.30; 95% CI, 0.05 –0.55; I2 = 0% ), and on balance based on the Berg score (SMD, 0.32; 95% CI, 0.06 –0.57; I2 = 49% ). Cycling with functional electrical stimulation had a positive effect on balance (SMD, 1.48; 95% CI, 0.99 –1.97; I2 = 91% ) compared with cycling alone. CONCLUSIONS:It appears that cycling has a positive effect on walking speed, walking ability and balance. Functional electrical stimulation combined with cycling has positive effects on balance beyond cycling alone.

Keywords: Meta-analysis, stroke, lower limb, cycling, disability, functional electrical stimulation

DOI: 10.3233/NRE-182671

Journal: NeuroRehabilitation, vol. 44, no. 3, pp. 389-412, 2019