Stroke is the third leading cause of disability and the second leading cause of death among adults. Lower limb dysfunction caused by stroke significantly impairs patients' quality of life. Numerous studies have demonstrated that core stability training (CST) can effectively improve lower limb function in stroke patients, and combining CST with other rehabilitation approaches may yield better therapeutic outcomes. This study aims to identify the most effective CST-based combined intervention for treating lower limb dysfunction in stroke patients. Method: Randomized controlled trials (RCTs) published up to July 22, 2024, were searched from PubMed, Embase, Cochrane Library, Web of Science, CNKI, and SinoMed. The quality of the included studies was assessed using the Cochrane Risk of Bias tool (ROB 2.0). Network meta-analysis was performed via R Studio and STATA 15.0. The optimal intervention strategy was explored using two-dimensional clustering analysis. For balance ability in stroke patients, the rehabilitation effect of neuromuscular electrical stimulation combined with core stability training (NMES+CST) was the most effective, with a surface under the cumulative ranking curve (SUCRA) of 91.09%. For functional mobility of the lower extremity in stroke patients, proprioceptive training combined with core stability training (PT+CST) showed the best rehabilitation effect (SUCRA=93.24%). For motor ability of the lower extremity, acupuncture therapy combined with core stability training (AT+CST) was the most effective (SUCRA=90.83%). For walking ability, motor imagery training combined with core stability training (MIT+CST) demonstrated the optimal rehabilitation effect (SUCRA=92.40%). Cluster analysis results indicated that the optimal treatment regimens for stroke-induced lower extremity dysfunction were PT+CST (SUCRA=56.75%/93.24%/63.59%/53.80%) and AT+CST (SUCRA=79.15%/ 90.83%/65.46%). NMES+CST, PT+CST, AT+CST, and MIT+CST are four effective core stability training combination therapies. Comprehensive evaluation results indicate that AT+CST or PT+CST is the optimal core stability training combination therapy for lower extremity dysfunction in stroke patients. Since AT is a traditional Chinese medicine treatment method, physicians should consider patients' acceptance of this intervention and cultural differences. Future research should explore long-term effects, individualized treatment protocols, and underlying mechanisms to optimize rehabilitation outcomes.
Zheng et al. (Thu,) studied this question.