Effectiveness of non-pharmacological interventions for lower limb motor impairment in post-stroke hemiplegia: a systematic review and Bayesian network meta-analysis.
TL;DR
Different non-pharmacological interventions may provide distinct benefits for lower limb rehabilitation after stroke; rTMS appears favorable for improving motor function, balance, and daily living ability; tDCS may help enhance walking independence; and virtual reality combined with robotic rehabilitation may be beneficial for functional mobility.
Abstract
Background
Stroke-related hemiplegia often results in significant lower limb dysfunction, severely affecting walking ability, balance, and daily activities. Although various non-pharmacological interventions have shown potential benefits, the optimal rehabilitation strategy remains unclear.
Objective
To evaluate the efficacy and comparative ranking of non-pharmacological interventions in improving lower limb motor function, balance, walking ability, and activities of daily living in individuals with post-stroke hemiplegia.
Methods
We conducted a search of PubMed, Embase, Cochrane Library, and Web of Science databases for randomized controlled trials (RCTs) published from January 2010 to August 2025. The Cochrane Risk of Bias Tool and Review Manager 5.4 were used to assess study quality, and evidence was graded with GRADEPro. Using R Studio software, a NMA was carried out to evaluate the clinical efficacy of various treatments in improving lower limb motor function in patients with post-stroke hemiplegia, ranked by the surface under the cumulative ranking curve (SUCRA). The study was officially registered in PROSPERO under the number CRD420251169037.
Results
A total of 82 RCTs involving 3514 participants and 16 non-pharmacological interventions were included. The results indicated that repetitive transcranial magnetic stimulation (rTMS) showed favorable effects on lower limb motor function measured by FMA-LE (MD = 3.7, 95% CI 2.5 to 4.9; SUCRA = 88.13%). rTMS also demonstrated positive effects on balance (MD = 8.5, 95% CrI: 5.1 to 11; SUCRA = 98.41%) and activities of daily living (MD = 14, 95% CrI: 11 to 16; SUCRA = 94.68%). For walking independence assessed by FAC, transcranial direct current stimulation (tDCS) showed considerable effects (MD = 1.5, 95% CrI: 0.41 to 2.5; SUCRA = 87.60%). Furthermore, virtual reality combined with robotic rehabilitation showed a relatively marked effect in reducing TUG time (MD = - 6.6, 95% CrI: - 8.9 to - 4.3; SUCRA = 95.27%).
Conclusion
Different non-pharmacological interventions may provide distinct benefits for lower limb rehabilitation after stroke. rTMS appears favorable for improving motor function, balance, and daily living ability; tDCS may help enhance walking independence; and virtual reality combined with robotic rehabilitation may be beneficial for functional mobility. Further large-scale, multicenter, standardized RCTs with longer follow-up are needed to confirm these findings.