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

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; I-2 = 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; I-2 = 0%), and on balance based on the Berg score (SMD, 0.32; 95% CI, 0.06 - 0.57; I-2 =49%). Cycling with functional electrical stimulation had a positive effect on balance (SMD, 1.48; 95% CI, 0.99 - 1.97; I-2 = 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.