Comparison of efficacy and safety of different types of electrical stimulation for shoulder subluxation after acute stroke: protocol for a systematic review and network meta-analysis of randomised controlled trials

Introduction Glenohumeral subluxation (GHS) is a common rehabilitation challenge in the hemiplegic upper limb following stroke, potentially leading to shoulder pain, secondary brachial plexus injury and various other complications. While electrical stimulation therapies, such as electromyography biofeedback, electroacupuncture and neuromuscular electrical stimulation, have shown promise in managing GHS, some controversy remains. Although clinical trials and meta-analyses have confirmed the efficacy of these therapies, healthcare professionals have yet to reach a consensus on which specific therapy is most effective for reducing shoulder subluxation (SS), alleviating pain and improving quality of life. This study will perform a network meta-analysis to compare the relative efficacy of different electrical stimulation therapies for treating GHS in patients following acute stroke.Methods and analysis We will systematically search the following databases: PubMed, MEDLINE, Embase, Cochrane Library, Web of Science, Chinese biomedical literature database (SinoMed), Wanfang databases (Wanfang), VIP Journal Integration Platform (VIP) and China National Knowledge Infrastructure (CNKI). Our search will cover the period from the inception of each database until 14 April 2025, and will be restricted to studies published in Chinese or English. The primary outcomes of interest will be the degree of improvement in SS, improvements in quality of life and reductions in pain. We will conduct pairwise meta-analyses using RevMan V.5.3 (The Cochrane Collaboration, Copenhagen, Denmark), and network meta-analyses using ADDIS V.1.16.6 (Drugis, Groningen, The Netherlands) and Stata V.16.0 (StataCorp, College Station, Texas, USA) to compare the relative efficacy of different electrical stimulation therapies. Screening, data extraction, risk of bias assessment and evaluation of the certainty of evidence will all be performed independently by two reviewers to ensure accuracy and reliability. The risk of bias within individual studies will be assessed using the Cochrane Risk of Bias 2 (ROB 2) tool, and the certainty of evidence will be evaluated using the Grading of Recommendations Assessment, and Evaluation (GRADE) and Confidence in Network Meta-Analysis (CINeMA) frameworks to ensure transparency and methodological rigour.Ethics and dissemination Ethical approval is not required for this study. The findings will be submitted to a peer-reviewed journal or conference.PROSPERO registration number CRD42024541228.