Abstract
Background:
Lower-extremity motor impairment after stroke is a major determinant of mobility limitation and persistent disability. Acupuncture is frequently used as an adjunct to conventional rehabilitation, but the magnitude and consistency of its effects on lower-limb recovery remain uncertain.
Methods:
This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to December 31, 2025, without language restrictions. Randomized controlled trials evaluating needle-based acupuncture for poststroke lower-limb recovery were included. Risk of bias was assessed using the Cochrane Risk of Bias tool for randomized trials version 2.0, and the certainty of evidence for the main outcomes was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. Meta-analyses were conducted in Stata 18.0 using random-effects models, and treatment effects for continuous outcomes were pooled as standardized mean differences (SMDs) with Hedges
g
correction and 95% confidence intervals (CIs). Because fewer than 10 studies contributed to each outcome, formal funnel-plot asymmetry tests, including Egger test, were not performed; publication bias was considered qualitatively.
Results:
Six trials met the inclusion criteria. Acupuncture was associated with improved lower-extremity motor function, as measured by the Fugl-Meyer Assessment Lower Extremity (SMD = 0.51, 95% CI = 0.32–0.71;
I
2
= 53.9%; low certainty). Balance assessed by the Berg Balance Scale also favored acupuncture but showed substantial heterogeneity (SMD = 0.96, 95% CI = 0.35–1.56;
I
2
= 91.5%; very low certainty). The Modified Barthel Index did not demonstrate a statistically significant benefit (SMD = 0.26, 95% CI = 0.16–0.68;
I
2
= 86.3%; very low certainty). The high heterogeneity for Berg Balance Scale and Modified Barthel Index indicates that these pooled estimates should be interpreted cautiously.
Conclusion:
Acupuncture may provide low-certainty incremental improvements in poststroke lower-extremity motor impairment. Evidence for balance and activities of daily living remains very uncertain because of substantial heterogeneity, limited sample size, and variability in acupuncture protocols and control conditions. Larger, prospectively registered, methodologically rigorous trials with standardized protocols, comparable rehabilitation dose, and clinically interpretable outcome reporting are needed.