Optimal Strategy of Resistance Training Combined With Other Rehabilitation Interventions for Lower-Limb Dysfunction in Stroke Patients: A Systematic Review and Network Meta-Analysis

Abstract

Objective: Stroke frequently results in lower-limb dysfunction, severely limiting independence. This study compared the effectiveness of resistance training alone and resistance training combined with other rehabilitation modalities in improving poststroke lower-limb function.

Design: A systematic review and Bayesian network meta-analysis were conducted following PRISMA guidelines. Randomized controlled trials involving resistance training alone or in combination with other therapies versus daily care or resistance training alone were included. The primary outcomes were balance, lower-limb motor function, and walking ability.

Results: Forty-seven trials with 2448 participants were analyzed. Resistance training combined with electrical stimulation therapy produced the greatest improvements in balance and lower-limb motor function, while resistance training combined with stretching training showed the best enhancement in walking ability. Surface Under the Cumulative Ranking Curve rankings indicated resistance training plus electrical stimulation therapy as most effective for balance (91.13%) and lower-limb motor function (79.70%), and resistance training plus stretching training for walking ability (96.34%).

Conclusions: Resistance training remains fundamental in stroke rehabilitation. Integrating resistance training with targeted adjunctive training particularly electrical stimulation therapy or stretching training yields superior therapeutic outcomes and supports individualized, evidence-based strategies for optimizing lower-limb recovery after stroke.

Keywords: Lower-Limb Dysfunction; Network Meta-Analysis; Resistance Training; Stroke Rehabilitation.