2022, Vol. 26 ›› Issue (29): 4742-4748

Electromyographic biofeedback for post-stroke limb spasticity: a Meta-analysis

Zhang Tiantian1, Li Jiamin1, Ou Liang2, Shang Yan1, Xu Yaqian3, Hu Guoheng1, 3   

Abstract: OBJECTIVE: Electromyographic biofeedback therapy has been widely used in post-stroke muscle rehabilitation training. The purpose of this paper is to systematically evaluate the efficacy of electromyographic biofeedback on treating post-stroke spasticity.
METHODS: The randomized controlled trials addressing electromyographic biofeedback in the treatment of post-stroke spasticity were retrieved from PubMed, Cochrane Library, Embase, CNKI, VIP, Chinese BioMedical Literature Database, and WanFang Database. The retrieval time ranged from database inception to June 2021. The risk of bias was evaluated by the Cochrane Collaboration tool and modified Jadad scale. Meta-analysis was performed using RevMan 5.4 software.
RESULTS: A total of 15 randomized controlled trials were included, and 878 samples were extracted. The results of Meta-analysis showed that treatment with electromyographic biofeedback ≤ 4 weeks or over 4 weeks showed a significantly lower modified Ashworth scale score [mean difference (MD)=-0.32, 95% confidence interval (CI): -0.45 to -0.19, P < 0.000 01; MD=-0.27, 95% CI: -0.37 to -0.17, P < 0.000 01] and significantly lower clinical spasticity index (MD=-2.05, 95% CI: -2.27 to -1.83, P < 0.000 01) compared with the control group. Compared with the control group, electromyographic biofeedback could significantly improve the motor function (upper limbs ≤ 4 weeks: MD=3.39, 95% CI: 2.02-4.77, P < 0.000 01; upper limbs > 4 weeks: MD=2.53, 95% CI: 2.04-3.02, P < 0.000 01; lower limbs > 4 weeks: MD=3.36, 95% CI: 2.90-3.83, P < 0.000 01; total score ≤ 4 weeks: MD=20.63, 95% CI: 19.38-21.88, P < 0.000 01; total score > 4 weeks: MD=8.08, 95% CI: 3.38-12.78, P=0.000 8), the active range of motion of the ankle joint (≤ 4 weeks: MD=4.87, 95% CI: 1.12-8.62, P=0.01; > 4 weeks: MD=3.69, 95% CI: 3.04-4.34, P < 0.000 01) and electrophysiological parameters (flexor group: MD=-16.80, 95% CI: -24.75 to -8.85, P < 0.000 1; extensor group: MD=17.88, 95% CI: 2.83-32.93, P=0.02) of the hemiplegic limbs.
CONCLUSION: Electromyographic biofeedback can effectively improve post-stroke limb spasticity and function. However, more high-quality randomized controlled trials are still needed to further verify its efficacy and safety.
Key words: stroke, spasticity, hemiplegia, electromyographic biofeedback, function, rehabilitation, randomized controlled trials, Meta-analysis