ObjectiveTo systematically evaluate the rehabilitation effect of blood flow restriction training (BFRT) as an adjunctive rehabilitation intervention on lower-limb motor function, balance ability, walking endurance and activities of daily living in stroke patients. MethodsRandomized controlled trials (RCT) on BFRT combined with rehabilitation training for stroke patients published from database inception to January 31, 2026 were retrieved from CNKI, Wanfang data, PubMed, Embase, Cochrane Library and Web of Science. Two researchers independently conducted literature screening, data extraction and bias risk assessment based on the PICO principle. Meta-analysis, subgroup analysis and sensitivity analysis were performed using RevMan 5.4.1 and Stata 17.0. ResultsA total of 15 RCT were included, involving 712 stroke patients including 354 in the control group and 358 in the experimental group. Compared with rehabilitation training, combination of BFRT significantly improved Fugl-Meyer Assessment-Lower Extremities scores (MD = 1.77, 95%CI 0.02 to 3.52, P = 0.047), Berg Balance Scale scores (MD = 5.39, 95%CI 2.20 to 8.59, P < 0.001) and 6-Minute Walk Test distance (MD = 10.24, 95%CI 7.76 to 12.72, P < 0.001). There was no significant difference in modified Barthel Index scores and Timed Up and Go Test results between two groups (P > 0.05). Subgroup analysis indicated that the intervention protocol with a duration of more than four weeks and BFRT combined with resistance training achieved better rehabilitation effect. ConclusionAs an adjunctive rehabilitation method, BFRT can significantly improve lower-limb motor function, balance and walking endurance of stroke patients, while its effect on activities of daily living and functional mobility remains unclear. The protocol of BFRT combined with resistance training for more than four weeks is preferentially recommended, which is more suitable for chronic stroke patients with stable condition, basic walking ability and no cognitive impairment.