Comparing the effects of different electromagnetic stimulation on lower limb motor impairment after stroke: a protocol for systematic review and network meta-analysis.

OBJECTIVE

Stroke is a leading cause of death and long-term disability worldwide. Most survivors develop multiple functional impairments, with lower limb dysfunction being particularly prevalent and impactful, and has emerged as a key factor undermining patients' quality of life. Electromagnetic stimulation therapy, a potential intervention for post-stroke lower limb rehabilitation, remains controversial regarding its clinical efficacy in current literature. Furthermore, no definitive conclusions exist regarding the comparative advantages of distinct electromagnetic stimulation protocols. Given these controversies and uncertainties, this study aims to perform a network meta-analysis (NMA) to systematically assess the effects of distinct electromagnetic stimulation protocols on post-stroke lower limb motor function. This analysis further aims to quantify differences in clinical benefits across these protocols and characterize their safety profiles, thereby offering evidence-based guidance for clinical decision-making.

METHODS

We will conduct a systematic search of the following eight databases: PubMed, Embase, the Cochrane Library, Web of Science, CNKI, the VIP Database, the Wanfang Database, and the China Biomedical Literature Database. The search will encompass randomized controlled trials published from the inception of each database until February 15, 2025. Subsequently, two independent reviewers will assess the risk of bias for all included studies using the Cochrane Risk of Bias tool (RoB 2). We will then perform an NMA using a random-effects model in Stata software to compare the efficacy and safety of various electrical stimulation therapies. The surface under the cumulative ranking curve (SUCRA) will be calculated to estimate the comparative benefits and harms of each intervention.

DISCUSSION: This evaluation protocol aims to generate evidence on the efficacy of various electromagnetic stimulation regimens for improving clinical symptoms in patients with post-stroke lower limb dysfunction. This evidence will thereby provide a theoretical foundation and practical insights to aid clinicians in optimizing diagnostic and therapeutic decision-making.

CLINICAL TRIAL REGISTRATION: https://www.crd.york.ac.uk/, identifier [CRD420251247508].