Effectiveness of Neuromuscular Electrical Stimulation on Lower Limbs of Patients With Hemiplegia After Chronic Stroke: A Systematic Review

Arch Phys Med Rehabil. 2018 May;99(5):1011-1022.e1. doi: 10.1016/j.apmr.2017.12.019. Epub 2018 Jan 31.


Objective: To investigate the effectiveness of neuromuscular electrical stimulation (NMES) with or without other interventions in improving lower limb activity after chronic stroke.

Data sources: Electronic databases, including PubMed, EMBase, Cochrane Library, PEDro (Physiotherapy Evidence Database), and PsycINFO, were searched from the inception to January 2017.

Study selection: We selected the randomized controlled trials (RCTs) involving chronic stroke survivors with lower limb dysfunction and comparing NMES or combined with other interventions with a control group of no electrical stimulation treatment.

Data extraction: The primary outcome was defined as lower limb motor function, and the secondary outcomes included gait speed, Berg Balance Scale, timed Up and Go, 6-minute walk test, Modified Ashworth Scale, and range of motion.

Data synthesis: Twenty-one RCTs involving 1481 participants were identified from 5759 retrieved articles. Pooled analysis showed that NMES had a moderate but statistically significant benefit on lower limb motor function (standard mean difference 0.42, 95% confidence interval 0.26-0.58), especially when NMES was combined with other interventions or treatment time within either 6 or 12 weeks. NMES also had significant benefits on gait speed, balance, spasticity, and range of motion but had no significant difference in walking endurance after NMES.

Conclusions: NMES combined with or without other interventions has beneficial effects in lower limb motor function in chronic stroke survivors. These data suggest that NMES should be a promising therapy to apply in chronic stroke rehabilitation to improve the capability of lower extremity in performing activities.

Keywords: Lower limb; Motor function; Neuromuscular electrical stimulation; Stroke; Systematic review.

Publication types

  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Chronic Disease
  • Electric Stimulation Therapy / methods*
  • Hemiplegia / etiology
  • Hemiplegia / physiopathology
  • Hemiplegia / rehabilitation*
  • Humans
  • Lower Extremity / physiopathology
  • Physical Therapy Modalities
  • Range of Motion, Articular
  • Recovery of Function
  • Stroke / complications*
  • Stroke / physiopathology
  • Stroke Rehabilitation / methods*
  • Treatment Outcome
  • Walk Test
  • Walking / physiology
  • Walking Speed