Effectiveness of Blood Flow Restriction Training in Neurological Rehabilitation: A Systematic Review and Meta-analysis

INTRODUCTION: Muscle weakness is a common impairment following neurological disorders, yet traditional high-load training aimed at addressing this is often impractical or unsafe for these patients. Blood flow restriction (BFR) training has emerged as a viable method, capable of eliciting physiological adaptations comparable to high-load training while using significantly lower mechanical loads. OBJECTIVE: This study aimed to summarize the clinical applications of BFR training for neurological disorders and assess its effectiveness and safety in improving muscle strength and functional outcomes. METHODS: The systematic review and meta-analysis followed PRISMA guidelines. PubMed, Embase, PEDro, Cochrane, CINAHL, CNKI were searched for intervention studies comparing BFR with diverse control interventions. The primary outcomes were muscle strength and functional outcomes. Sensitivity analyses, subgroup analysis and meta-regression were also performed. RESULTS: Thirty-seven studies involving 963 participants were included, with individuals having stroke (n = 639), Parkinson's disease (n = 18), multiple sclerosis (n = 128), spinal cord injury (n = 170), cerebral palsy (n = 1), peripheral nerve injury (n = 2), and transverse myelitis (n = 1). Our results revealed that the addition of BFR significantly increased muscle strength, with effect sizes of 0.752 (95% CI 0.49-1.02). Significant improvements were also observed in balance, Fugl-Meyer Lower Extremity assessment, and Modified Barthel Index. Subgroup analyses revealed that onset time was a crucial factor for the effectiveness of BFR on clinical outcomes. Furthermore, BFR training demonstrated overall safety in neurological rehabilitation. CONCLUSION: These findings support the effectiveness of BFR training in improving muscle strength and functional outcomes in neurological rehabilitation, without any significant adverse events. However, further high-quality research is needed to validate the efficacy of BFR and refine its training protocols for individuals with neurological disorders.