Stroke: electromyographic biofeedback may improve ankle muscle strength.

Clinical bottom line (level 1a)

  1. Patients who had a stroke and required rehabilitation who were given electromyographic biofeedback, may be more likely to have improved ankle muscle strength than those not given it.
  2. Patients given electromyographic biofeedback had no clear difference in gait quality, ankle range of motion, ankle angle during gait, stride length and gait speed, than those not given it.
Moreland et al: Archives of Physical Medicine and Rehabilitation 1998; 79: 134-140
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The study

Systematic review of randomised controlled trials of
  • Patients: poststroke adults
  • Intervention: electromyographic biofeedback alone or with conventional physiotherapy compared with conventional physiotherapy
  • Outcome: functional measures of the lower extremity, including lower extremity function tests and walking, stage of motor recovery, range of motion and muscle strength


    • Articles found in English using MEDLINE and CINAHL, 1976 to 1995 (search terms: electromyography, biofeedback and cerebrovascular disorders in MEDLINE; biofeedback and cerebral vascular accident in CINAHL ) and hand searching of EXCERPTA MEDICA, contacting first authors of appropriate studies by mail to obtain further published or unpublished studies.

    Selection criteria: as above
    Appraisal criteria: detailed in text
    Articles excluded if: outcome data not available in published report and could not be obtained from the authors

    8 studies were included
    • A random effects model was used to combine outcomes.
    • Ankle range of motion was reported in 4 studies; gait quality in 3 studies; ankle angle and stride length during gait reported in 3 studies; ankle strength reported in 2 studies.

    The evidence

    • The pooled effect size of ankle muscle strength (electromyographic biofeedback versus control) is 1.17 (CI 0.50 to 1.85).
    • The pooled effect size of gait quality (treatment versus control) is 0.48 (CI -0.06 to 1.01).
    • The pooled effect size of ankle range of motion is 0.07 (CI -0.42 to 0.57).
    • The pooled effect size of ankle angle during gait is 0.51 (CI -0.17 to 1.21).
    • The pooled effect size of stride length is 0.09 (CI -0.56 to 0.73).
    • The pooled effect size of gait speed is 0.31 (CI -0.16 to 0.78).
    • Effect size (or standardised mean difference) is calculated by subtracting pretreatment scores from posttreatment scores divided by either the posttreatment standard deviation.

    Citation

    1. Moreland JD, Thomson MA, Fuoco AR: Electromyographic biofeedback to improve lower extremity function after stroke: A meta-analysis. Archives of Physical Medicine and Rehabilitation 1998; 79: 134-140
    Contributor: Clare Wotton and Musab Hayatli, November 1999
    Reviewer:

    Clinical Question.
    Patient stroke
    Intervention or Exposure electromyographic biofeedback
    Comparison no biofeedback
    Outcome improvement of lower extremity function