Effectiveness of Functional Electrical Stimulation Assisted Locomotor Training on walking Outcomes Following Incomplete Spinal Cord Injury: Systematic Review and Meta-Analysis.

Only 3 randomized trials were suitable for the meta-analysis. The included randomized trials had small samples, with 142 participants analyzed after attrition, and only one trial had low risk of bias. All 9 quasi-experimental studies were rated serious risk of bias, mainly from confounding and outcome measurement. The interventions varied in type, dose, and support, with randomized trial doses from 25 minutes to 3 hours daily, 3 to 5 days weekly, and 4 to 24 weeks total. Control groups varied from no intervention to other locomotor training to aerobic-resistance training, so the comparison was not consistent. FES parameters were often not reported, and only one randomized trial reported frequency, pulse duration, and amplitude. The randomized trials lost 4 to 10 participants each through attrition. Long-term follow-up was limited, and only one study reassessed participants 2 and 8 months after the intervention ended and found no significant effects.

The authors declared no conflicts of interest. The work was supported in part by Praxis Spinal Cord Institute, and one author was supported by a Canada Research Chair.

Do not conclude that electrical stimulation alone improved walking. The interventions combined FES with locomotor training, often with body-weight support, robotic assistance, manual assistance, or broader activity-based therapy. The pooled randomized trials did not show significant improvement in walking speed or endurance compared with active controls, and the studies varied widely in dose and reporting.