The therapeutic effect of functional and transcutaneous electric stimulation on improving gait speed in stroke patients: A meta-analysis

Objective: To determine the effect of previous treatments of functional electric stimulation (FES) and transcutaneous electric stimulation (TENS) on improving gait speed in subjects poststroke. Data Sources: Relevant articles were obtained through a search of English-language articles cited in Medline, EMBASE, CINHAL, and PubMed databases from January 1966 to May 2005. Study Selection: Prospective clinical studies were included if electric stimulation was used to treat subjects poststroke and gait speed was used as an outcome measure. Excluded studies examined subjects with a variety of neurologic conditions, used implantable electrodes, or combined electric stimulation with treadmill training. A paired consensus between authors produced 8 articles. Data Extraction: Two investigators extracted data independently. The methodologic quality of the Studies was assessed with the Downs and Black checklist. Data Synthesis: A fixed-effects model produced a mean difference (.18; 95% confidence interval, .08-.28) that was significant (z=3.65, P <.01), indicating the effectiveness of FES treatment at increasing gait speed in subjects poststroke. The effect sizes of the studies ranged from -.11 to 1.43 for FES and .19 to.42 for TENS. The type of FES and TENS devices, location of electrodes, amount of exposure, and subjects' stages of recovery varied between the studies. Conclusions: FES is effective at improving gait speed in subjects poststroke. Future research should examine the effectiveness of practical and readily available FES units to improve function in subjects in the subacute stages of recovery from a stroke. These studies should attempt to use a randomized controlled design with blinding and standardized outcome measures.