OBJECTIVE: To examine the efficacy of electromyographic (EMG) biofeedback compared with conventional physiotherapy for improving lower extremity function in stroke patients. DATA SOURCES: A literature search covering the years 1976 to 1995 in Medline, CINAHL, and EXCERPTA MEDICA. STUDY SELECTION: Studies of adults after stroke, in which the treatment group received biofeedback alone or with conventional physical therapy and the control group received conventional physical therapy. Outcomes included functional measures related to the lower extremity. The study design criterion was that all must be randomized controlled trials. DATA EXTRACTION: Study quality was assessed independently by two observers-using eight criteria. Data for analysis were extracted by two observers to ensure accuracy. DATA SYNTHESIS: For outcomes that were analyzed in more than one study, meta-analyses were done. Seventy-nine studies were identified as potentially relevant and eight studies met the selection criteria. The mean effect sizes were: for ankle dorsiflexion muscle strength, 1.17 (95% CI 0.50 to 1.85; p = 0.0006); for gait quality, 0.48 (95% CI -0.06 to 1.01; p = 0.08); for ankle range of motion, 0.07 (95% CI -0.42 to 0.57; p = 0.78); for ankle angle during gait, 0.52 (95% CI -0.18 to 1.21; p = 0.14); for stride length, 0.09 (95% CI -0.56 to 0.73; p = 0.80); and for gait speed, 0.31 (95% CI -0.16 to 0.78; p = 0.20). CONCLUSIONS: The results indicate that EMG biofeedback is superior to conventional therapy alone for improving ankle dorsiflexion muscle strength.

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