NO efficacy percentages and NO PROTOCOLS, so you completely failed at your research! Are your mentors and senior researchers that incompetent they don't know how to direct research?
Efficacy of functional electrical stimulation at different frequencies for post-stroke foot drop: a retrospective cohort study
Abstract
Objective:
To compare the efficacy and safety of low, medium, and high-frequency functional electrical stimulation (FES) in post-stroke foot drop (FD), aiming to identify optimal frequency parameters for clinical practice.
Methods:
In this retrospective cohort study, 90 patients with post-stroke FD admitted between January 2021–December 2023 were grouped based on received FES frequency: low-frequency (20–30 Hz, n = 30), medium-frequency (31–40 Hz, n = 30), and high-frequency (41–50 Hz, n = 30). All patients received conventional rehabilitation combined with FES. The primary efficacy outcome was the improvement in 10-meter maximum walking speed (10MWS). Secondary outcomes included Fugl-Meyer Assessment for Lower Extremity (FMA-LE) scores and Functional Ambulation Category (FAC), and ankle dorsiflexor muscle strength.
Results:
Baseline characteristics were comparable (all p > 0.05). The medium-frequency group showed significantly greater improvement in 10MWS (0.246 ± 0.095 m/s) versus low (0.154 ± 0.063 m/s) and high-frequency groups (0.145 ± 0.050 m/s) (p < 0.001). FMA-LE improvement was also superior in the medium-frequency group (8.60 ± 1.99 points; p < 0.001). Ankle dorsi-flexor strength improvement was significantly greater in the medium-frequency group (1.93 ± 0.25 grade) compared to both low (0.97 ± 0.18 grade) and high-frequency groups (1.03 ± 0.18 grade) (p < 0.001), with a favorable trend also observed in FAC. Adverse event incidence was low (3.3%) and similar across groups (p = 0.355). Subgroup analysis indicated consistent medium-frequency efficacy across stroke types.
Conclusion:
In this retrospective comparative study, medium-frequency (31–40 Hz) FES was associated with optimal efficacy and safety outcomes for post-stroke FD, showing significantly greater improvement in walking speed and lower limb function without added risk. These findings suggest it as a promising parameter for clinical evaluation, though verification by prospective trials is warranted.
1 Introduction
Stroke remains one of the leading global causes of disability and mortality (1, 2). Epidemiological data indicate a significant increase in the overall burden of stroke from 1990 to 2021, reflected by a 70.0% rise in new cases, a 44.0% increase in deaths, an 86.0% growth in prevalence, and a corresponding 32% increase in disability-adjusted life years (3). Stroke-induced impairments extensively affect multiple dimensions, including physical function, occupational participation, communication ability, and social integration (4), with motor dysfunction being particularly prominent; approximately 80% of survivors experience varying degrees of limb motor impairment (5). Foot drop (FD), a common manifestation of motor dysfunction, is characterized primarily by weakness in ankle dorsiflexion and eversion. This leads to diminished mobility, impaired balance, and reduced walking efficiency, subsequently increasing the risk of falls and significantly constraining patients’ quality of daily life and level of social participation (6).
Electrical stimulation is among the effective treatments for alleviating walking dysfunction after stroke. In particular, functional electrical stimulation (FES) has become a standard neurorehabilitation intervention for post-stroke FD (7, 8). This is supported by high-level evidence, such as a systematic review and meta-analysis of randomized controlled trials which concluded that FES significantly improves walking speed in ambulatory stroke survivors (9). This technique involves stimulating the common peroneal nerve via surface electrodes during the swing phase of gait to elicit ankle dorsiflexion, thereby effectively correcting gait abnormalities (10). The underlying mechanisms include FES’s ability not only to stimulate voluntary muscle activity, directly ameliorating FD and reducing spasticity, but also to promote long-term functional reorganization of the sensorimotor cortex (11, 12).
However, despite the established efficacy of FES, optimizing its treatment parameters remains a key challenge in current rehabilitation medicine research. Stimulation frequency, as a core FES parameter, directly influences muscle contraction characteristics, the degree of neuromuscular fatigue, and the ultimate functional output. Although the commonly used clinical frequency range is broad (20–50 Hz), aiming to elicit functional contraction of target muscles by activating motor nerve fibers (11), a consensus on the optimal frequency is lacking and significant controversy persists. Some studies support the use of lower frequencies to achieve smoother muscle contractions (13), while other evidence suggests that higher frequencies offer advantages in improving muscle strength and motor activation characteristics (14). This uncertainty in clinical practice stems primarily from a lack of high-quality studies directly and systematically comparing different frequencies. Indeed, recent reviews have explicitly highlighted the need for further comparisons of the effects of neuromuscular electrical stimulation with different stimulation frequencies (11).
Based on the premise that higher frequencies might generate stronger muscle contractions, we initially hypothesized that high-frequency FES would yield superior functional outcomes compared to low-frequency stimulation. Therefore, this clinical efficacy study aims, via a retrospective cohort design, to systematically compare the functional outcomes of FES at three commonly used frequency ranges (low: 20–30 Hz, medium: 31–40 Hz, high: 41–50 Hz) on walking function, lower limb motor function, and safety in patients with post-stroke FD. The primary goal is to inform optimal parameter selection for clinical practice, rather than to elucidate underlying neurophysiological mechanisms.
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