Currently submitted to: JMIR Rehabilitation and Assistive Technologies
Date Submitted: Dec 25, 2025
Open Peer Review Period: Jan 13, 2026 - Mar 10, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Functional Electrical Stimulation for Post-Stroke Motor Recovery: A Systematic Review and Meta-Analysis of Recent Evidence
ABSTRACT
Background:
: Stroke remains a leading cause of motor disability globally. Functional electrical stimulation (FES) has emerged as a promising neurorehabilitation modality, but its comparative efficacy, optimal application parameters, and long-term sustainability remain incompletely characterized.
Objective:
To synthesize evidence from randomized controlled trials and systematic reviews published between 2021 and 2025 regarding the effectiveness of FES interventions for upper and lower limb motor recovery in post-stroke populations.
Methods:
A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Cochrane Library databases. Studies were selected based on PRISMA 2020 criteria. Quality appraisal was performed using the Physiotherapy Evidence Database (PEDro) scale and Cochrane Risk of Bias 2 tool. Quantitative synthesis was conducted using random-effects meta-analyses.
Results:
Twenty-seven studies (n=2,309 stroke participants) were included, encompassing diverse FES modalities: manually controlled, electromyography-triggered, brain-computer interface-controlled, and hybrid systems. Meta-analytic findings demonstrated that FES combined with occupational therapy produced significantly greater improvements in upper limb motor function (Fugl-Meyer Assessment: mean difference [MD] = 5.08, 95% confidence interval [CI] 2.46-7.71) compared to standard care alone. Brain-computer interface-controlled FES achieved superior outcomes (standardized mean difference [SMD] = 0.73, 95% CI 0.26-1.20) particularly when paired with action observation tasks. For lower limb recovery, FES reduced foot drop severity and enhanced gait parameters, with 52% of participants achieving independent walking. Cost-effectiveness analysis demonstrated long-term value (£15,406 per quality-adjusted life year). Adverse events were minimal, primarily limited to temporary skin irritation.
Conclusions:
FES represents a viable, evidence-supported adjunctive intervention for post-stroke motor recovery across subacute and chronic phases. Emerging technologies integrating brain-computer interfaces and artificial intelligence offer enhanced personalization and efficacy. Future research should prioritize real-world implementation trials, long-term follow-up protocols, and mechanisms underlying neuroplastic adaptations.
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