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

Introduction Functional electrical stimulation (FES) may enhance the impact of locomotor training on walking impairments following spinal cord injury (SCI). Objective This systematic review (PROSPERO: CRD42023435210) evaluated the therapeutic effectiveness of FES-assisted locomotor training (FALT) on improving walking speed and endurance for individuals with motor incomplete SCI (iSCI). Methods Databases (MEDLINE, EMBASE, CINAHL) were searched for interventional studies of FALT in iSCI that assessed the therapeutic effects on walking speed and/or endurance when the FES was not active. Study characteristics and findings were extracted, summarized, and narratively synthesized. Risk of bias was assessed using the Cochrane tools for interventional studies. Random effects meta-analyses were conducted to generate standardized pooled effect sizes for both outcomes. Results Thirteen studies were identified: 4 randomized controlled trials (RCTs) and 9 pre-post tests. RCTs scored low ( n = 1 study), intermediate ( n = 1), and high ( n = 2) on the RoB2, and all pre-post tests studies ( n = 9) scored high on the ROBINS-I. Meta-analyses of 3 RCTs found that treadmill-based FALT was associated with a small, non-significant effect on walking speed ( n = 76 participants; Hedge’s g : −0.01; 95% CI: −0.46, 0.43; P = .96) and a small, non-significant effect on walking endurance ( n = 71; Hedge’s g : 0.20; 95% CI: −0.25, 0.65; P = .39) when compared to control conditions. Discussion This review did not find evidence that FALT improves walking speed or endurance for people with iSCI relative to other types of locomotor training. Future trials of FALT for SCI should aim to better standardize and report training dose and stimulation parameters to improve comparability.