FES cycling shows small, non-significant effects on gait in stroke survivors

BACKGROUND AND PURPOSE: People with stroke often experience gait impairments. Functional electrical stimulation (FES) cycling allows patients with little or no voluntary lower limb movement to pedal a stationary bicycle. This review examines the effects of FES cycling on gait ability post-stroke. METHODS: "PubMed, SCOPUS, EMBASE, REHABDATA, CINAHL, MEDLINE, PEDro, and Web of Science" were reviewed until July 10, 2024. Randomized controlled trials that included ischemic or hemorrhagic stroke patients who received lower limb FES cycling, compared with passive or active interventions, and assessed gait parameters (i.e., kinematic, kinetic, spatial, temporal) were included in this review. The risk of bias was assessed using the PEDro scale. The results were analyzed using Comprehensive Meta-Analysis Version 4. RESULTS: Ten studies met our criteria. In total, 311 patients with stroke (mean age 63.44 years; 58% male) were included in this review. Gait speed, walking endurance, and spatiotemporal gait variables were assessed as outcomes. The included studies ranged from 6 to 9 on the PEDro scale, with a median of 8. The meta-analysis showed a small, non-significant effect of FES cycling on gait in stroke patients, including the 10-m Walk Test (SMD = -0.160, 95% CI: -0.631 to 0.311, p = 0.505, I = 60%), the 50-m Walk Test (SMD = -0.071, 95% CI: -0.841 to 0.700, p = 0.857, I = 66%), and the 6-Minute Walk Test (SMD = -0.083, 95% CI: -0.739 to 0.574, p = 0.806, I = 55%). Some descriptive outcomes showed improvements in gait parameters, but the overall evidence remains inconclusive. DISCUSSION: The evidence for the effects of FES cycling on gait ability in patients with stroke is limited. The optimal treatment parameters are not yet firmly established. Additional high-quality studies are recommended.