Impact of acupuncture on lower limb motor function recovery after stroke: A systematic review and meta-analysis

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.

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.