Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Sunday, May 17, 2026

Comparative effectiveness of neuromuscular electrical stimulation-based combination interventions for post-stroke lower limb rehabilitation: a systematic review and network meta-analysis

 Why didn't you write protocols for the effective ones?

Laziness? Incompetence? Or just don't care? NO leadership? NO strategy? Not my job? Not my Problem!

Comparative effectiveness of neuromuscular electrical stimulation-based combination interventions for post-stroke lower limb rehabilitation: a systematic review and network meta-analysis

    We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

    Abstract

    Objective

    This study aimed to comparatively evaluate the efficacy of different neuromuscular electrical stimulation (NMES)-based combination protocols for improving lower limb dysfunction in patients with stroke, in order to provide evidence-based support for clinical rehabilitation practice.

    Methods

    Randomized controlled trials (RCTs) investigating NMES-based combination interventions for lower limb dysfunction in patients with stroke published up to September 2, 2025 were systematically identified through searches of PubMed, Embase, the Cochrane Library, and Web of Science. The risk of bias of eligible studies was evaluated using the Cochrane Risk of Bias 2.0 (ROB 2.0) tool. Network meta-analysis (NMA) and subgroup analyses were conducted using R software (version 4.5.1) and Stata (version 15.0).

    Results

    In total, 37 RCTs were incorporated into the present NMA, involving 1,764 patients with stroke and encompassing nine distinct NMES-based combination intervention protocols. Regarding balance ability, core stability training (CST) combined with NMES (SMD = 0.99, 95% CrI: 0.33–1.67), gait training (GT) combined with NMES (SMD = 0.83, 95% CrI: 0.35–1.27), and NMES alone (SMD = 0.71, 95% CrI: 0.21–1.22) demonstrated significant therapeutic effects. CST+NMES (SUCRA = 76.02%) ranked highest among the NMES-based combined interventions for balance ability in patients with stroke. With respect to walking ability, no statistically significant differences were observed among the NMES-based intervention comparisons. Nevertheless, cycling exercise (CE) combined with NMES (SUCRA = 77.46%) received the highest ranking probability for walking ability, although this exploratory finding should be interpreted with caution given the absence of statistically significant differences among interventions and the lack of closed loops in the network. In terms of lower limb functional mobility, augmented reality technology (ART) combined with GT and NMES (SMD = 1.38, 95% CrI: 0.25–2.52), GT+NMES (SMD = 0.85, 95% CrI: 0.39–1.36), and NMES alone (SMD = 0.55, 95% CrI: 0.06–1.05) showed significant improvements. ART+GT+NMES (SUCRA = 84.23%) ranked highest for lower limb functional mobility. The results of the two-dimensional cluster ranking indicated that GT+NMES (SUCRA = 65.22%/49.29%/62.22%) demonstrated relatively stable ranking performance across multiple domains of lower limb dysfunction in patients with stroke. Subgroup analyses further indicated that CST+NMES appeared to be more effective for patients in the acute phase, GT+NMES for those in the subacute phase, and ART+GT+NMES for patients in the chronic phase. These subgroup-level rankings were based on limited evidence and should be considered exploratory.

    Conclusions

    NMES-based combination strategies have demonstrated beneficial effects on the recovery of lower limb function among individuals after stroke. Based on the results of this NMA, GT+NMES demonstrated relatively stable ranking performance across multiple outcomes, including balance, walking ability, and lower limb functional mobility, suggesting that it warrants further investigation(Why? You incompetently didn't do your job correctly?) as a combined intervention for clinical application. In addition, patients at different stages of stroke showed variable responses to NMES-based combined interventions, highlighting the importance of stage-specific and individualized rehabilitation strategies.

    Trial registration: PROSPERO CRD420251229835.

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