title: Cyclical electrical stimulation increases strength and improves activity after stroke: a systematic review.
abstract: OBJECTIVE
  Does electrical stimulation increase strength after stroke and are any benefits maintained beyond the intervention period or carried over to activity?
  
  
  METHODS
  Systematic review with meta-analysis of randomised or controlled trials.
  
  
  METHODS
  Adults who have had a stroke.
  
  
  METHODS
  Cyclical electrical stimulation applied in order to increase muscle strength.
  
  
  METHODS
  Strength measures had to be representative of maximum voluntary contraction and were obtained as continuous measures of force or torque, or ordinal measures such as manual muscle tests. Activity was measured using direct measures of performance that produced continuous or ordinal data, or with scales that produced ordinal data.
  
  
  RESULTS
  Sixteen trials representing 17 relevant comparisons were included in this systematic review. Effect sizes were calculated as standardised mean differences because various muscles were studied and different outcome measures were used. Overall, electrical stimulation increased strength by a standardised mean difference (SMD) of 0.47 (95% CI 0.26 to 0.68) and this effect was maintained beyond the intervention period (SMD 0.33, 95% CI 0.07 to 0.60). Electrical stimulation also improved activity (SMD 0.30, 95% CI 0.05 to 0.56) and this effect was also maintained beyond the intervention period (SMD 0.38, 95% CI 0.09 to 0.66).
  
  
  CONCLUSIONS
  Cyclical electrical stimulation increases strength and improves activity after stroke. These benefits were maintained beyond the intervention period with a small-to-moderate effect size. The sustained effect on activity suggests that the benefits were incorporated into daily life. Review registration: PROSPERO (CRD42013003895).
authors.affiliation: Discipline of Physiotherapy, The University of Sydney, Australia; Discipline of Physiotherapy, Universidade Federal de Minas Gerais.
authors.forename: Lucas R
authors.initials: LR
authors.lastname: Nascimento
authors.affiliation: Discipline of Physiotherapy, The University of Sydney, Australia; Discipline of Physiotherapy, Universidade do Estado de Santa Catarina, Brazil.
authors.forename: Stella M
authors.initials: SM
authors.lastname: Michaelsen
authors.affiliation: Discipline of Physiotherapy, The University of Sydney, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Ada
authors.affiliation: Discipline of Physiotherapy, The University of Sydney, Australia; Discipline of Physiotherapy, Universidade Federal de Minas Gerais.
authors.forename: Janaine C
authors.initials: JC
authors.lastname: Polese
authors.affiliation: Discipline of Physiotherapy, Universidade Federal de Minas Gerais.
authors.forename: Luci F
authors.initials: LF
authors.lastname: Teixeira-Salmela
mesh_terms: D000368:Aged; D004599:Electric Stimulation Therapy; D006801:Humans; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D053580:Muscle Strength / Q000502:physiology*; D018482:Muscle, Skeletal / Q000503:physiopathology; D017063:Outcome Assessment, Health Care; D020521:Stroke / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
keywords: Electrical stimulation; Meta-analysis; Randomised controlled trial; Strength; Stroke; Systematic review