Comparative Efficacy of Electrical Stimulation Therapies for Bone Healing

OBJECTIVE: This network meta-analysis aimed to evaluate the effectiveness of electrical stimulation (ES) in promoting bone healing and to identify the optimal modality. DESIGN: This network meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA, Supplemental Digital Content 4, https://links.lww.com/PHM/D49) guidelines. PubMed, Cochrane, Embase, and Web of Science were searched up to January 2, 2025 for relevant RCTs. Study quality was assessed by two independent reviewers. Data were analyzed using R 4.3.1 and Stata 15.1. RESULTS: A total of 37 RCTs (3,325 subjects) were included. Overall, ES therapy improved bone healing rates compared to controls (RR 1.18, 95% CI 1.09-1.28), with pulsed electromagnetic fields (PEMF; RR 1.20, 95% CI 1.02-1.41) and combined magnetic fields (CMF; RR 1.49, 95% CI 1.14 -1.95) being particularly effective. For functional recovery, non-invasive interactive neurostimulation (NIN) ranked highest, with a surface under the cumulative ranking curve (SUCRA) value of 95.32%, followed by PEMF (SUCRA 64.64%) and transcutaneous electrical acupoint stimulation (TEAS; SUCRA 60.54%). CONCLUSIONS: ES therapy promotes bone healing, with PEMF appearing the most effective modality. However, additional high-quality RCTs are needed to confirm these findings and guide clinical application.