Systematic review and meta-analysis of the effectiveness of non-pharmacological interventions in restoring lower limb motor function after stroke

Objective To evaluate the effectiveness of non-pharmacological interventions in improving lower limb motor function in patients after stroke based on a systematic review and meta-analysis of randomized controlled trials. Methods A systematic literature search was conducted in PubMed (MEDLINE), Scopus, and the Cochrane Library, supplemented by manual screening of reference lists. Randomized controlled trials involving adult patients after stroke comparing non-pharmacological interventions with conventional rehabilitation were included. The primary outcome was lower limb motor function assessed by the Fugl–Meyer Assessment of the Lower Extremity (FMA-LE). The review was conducted in accordance with the PRISMA 2020 guidelines. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. A random-effects model was applied to calculate pooled mean differences (MDs) with 95% confidence intervals. Results Fifteen randomized controlled trials were included in the systematic review, of which 14 studies involving 623 participants were included in the quantitative synthesis. Non-pharmacological interventions demonstrated a statistically significant improvement in lower limb motor function compared with conventional rehabilitation (MD = 3.06, 95% CI 1.97–4.16; Z = 5.48, p < 0.00001), with substantial heterogeneity ( I 2 = 60%). In the subgroup analysis, robotic/mechanized rehabilitation interventions showed a significant positive effect (MD = 3.00, 95% CI 1.66–4.33; I 2 = 57%), as did other non-pharmacological interventions (MD = 3.15, 95% CI 0.94–5.35; I 2 = 68%). There was no statistically significant difference between the subgroups ( p = 0.91; I 2 = 0%). Conclusion Non-pharmacological rehabilitation interventions were associated with a statistically significant improvement in lower limb motor function after stroke compared with conventional rehabilitation. Substantial heterogeneity was observed across the included studies, highlighting the need for further high-quality randomized controlled trials with standardized intervention protocols and longer follow-up. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251154919 .