Comparative efficacy of brain-computer interface-coupled robotic rehabilitation, robot-assisted therapy, and motor imagery for upper-limb motor recovery after stroke: a systematic review and network meta-analysis.

Λεπτομέρειες βιβλιογραφικής εγγραφής
Τίτλος:	Comparative efficacy of brain-computer interface-coupled robotic rehabilitation, robot-assisted therapy, and motor imagery for upper-limb motor recovery after stroke: a systematic review and network meta-analysis.
Συγγραφείς:	Wu Y; Department of Nursing, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.; School of Nursing, Capital Medical University, Beijing, 100069, China., Zhang R; Department of Nursing, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China., Wu F; Department of Nursing, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.; School of Nursing, Capital Medical University, Beijing, 100069, China., Liu M; Department of Nursing, Hainan Provincial People's Hospital, Haikou, 570311, China., Wang Y; Department of Nursing, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.; School of Nursing, Capital Medical University, Beijing, 100069, China., Sun W; Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China. 1926887584@qq.com., Cai W; Department of Nursing, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China. ttyyhlb@163.com.
Πηγή:	Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology [Neurol Sci] 2026 Sep 25; Vol. 47 (10). Date of Electronic Publication: 2026 Sep 25.
Τύπος έκδοσης:	Journal Article; Systematic Review; Network Meta-Analysis; Comparative Study
Γλώσσα:	English
Στοιχεία περιοδικού:	Publisher: Springer-Verlag Italia Country of Publication: Italy NLM ID: 100959175 Publication Model: Electronic Cited Medium: Internet ISSN: 1590-3478 (Electronic) Linking ISSN: 15901874 NLM ISO Abbreviation: Neurol Sci Subsets: MEDLINE
Imprint Name(s):	Original Publication: Milano, Italy : Springer-Verlag Italia, c2000-
Ιατρικοί όροι (MeSH):	Stroke Rehabilitation/methods , Robotics/methods , Recovery of Function/physiology , Upper Extremity/physiopathology , Stroke/therapy , Stroke/physiopathology , Stroke/complications , Imagery, Psychotherapy/methods , Brain-Computer Interfaces*, Humans ; Treatment Outcome
Περίληψη:	Objective: To compare and rank the efficacy of brain-computer interface-coupled robotic rehabilitation (BCI-robot), robot-assisted therapy, motor imagery (MI), and conventional rehabilitation for upper-limb recovery after stroke, and to explore whether treatment effects differed according to key clinical and intervention-related characteristics. Methods: A systematic search was conducted in 11 databases from inception to March 31, 2026. Randomized controlled trials enrolling adults with post-stroke upper-limb motor impairment were included. The primary outcome was the Fugl-Meyer Assessment of Upper Extremity (FMA-UE). Secondary outcomes included the Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), and Modified Barthel Index (MBI). Direct pairwise meta-analyses were performed using mean differences (MDs) with 95% confidence intervals (CIs), and a frequentist network meta-analysis was conducted to synthesize direct and indirect evidence and rank interventions using P-scores. Results: Twenty-three reports representing 22 independent study cohorts were included, comprising 727 participants. Network meta-analysis showed no significant inconsistency, and the consistency model was adopted. BCI-robot ranked highest for improving FMA-UE according to the P-score analysis (P-score = 0.992), followed by robot-assisted therapy (0.641), MI (0.240), and conventional rehabilitation (0.127). In direct comparisons, BCI-robot produced a statistically significant improvement in FMA-UE versus conventional rehabilitation (MD = 6.80, 95% CI 4.29 to 9.30). The point estimate exceeded the 5.25-point (minimal clinically important difference) MCID, although the lower confidence limit did not. Compared with robot-assisted therapy, BCI-robot showed a statistically significant but small improvement (MD = 2.04, 95% CI 0.29 to 3.78), with both the point estimate and the entire 95% CI remaining below the MCID. Follow-up-duration subgroup analyses suggested that BCI-robot remained favorable over conventional rehabilitation in both < 3-month and ≥ 3-month subgroups, whereas no significant follow-up advantage over robot-assisted therapy was observed. For secondary outcomes, BCI-robot significantly improved WMFT versus conventional rehabilitation (MD = 8.94, 95% CI 5.22 to 12.65) and MBI versus conventional rehabilitation (MD = 3.37, 95% CI 0.10 to 6.63). A significant benefit for MBI versus robot was also observed (MD = 8.61, 95% CI 1.76 to 15.46), although this result was not robust in sensitivity analysis. No significant advantage was found for ARAT. Exploratory subgroup analyses suggested that, compared with robot-assisted therapy, the additional benefit of BCI-robot was more apparent in studies delivering more than four sessions per week. Conclusions: BCI-robot ranked highest for improving FMA-UE and may provide a clinically important benefit over conventional rehabilitation, although the magnitude remains uncertain. Its additional benefit over robot-assisted therapy was small and unlikely to be clinically important. Evidence for longer-term effects and for activity-level and daily-function outcomes remains limited, and the findings should be interpreted cautiously. (© 2026. Fondazione Società Italiana di Neurologia.)
Competing Interests:	Declarations. Ethics approval: Not applicable. Informed consent: Not applicable. Conflict of interest: The authors have no competing interests to declare that are relevant to the content of this article.
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Grant Information:	2026JD06 Capital Health Management and Policy Research Base; ZHKY202526 Chinese Nursing Association
Contributed Indexing:	Keywords: Brain–computer interface; Network meta-analysis; Robotic rehabilitation; Stroke; Systematic review; Upper-limb recovery
Entry Date(s):	Date Created: 20260925 Date Completed: 20260925 Latest Revision: 20261009
Update Code:	20261009
DOI:	10.1007/s10072-026-09375-9
PMID:	42789169
Βάση Δεδομένων:	MEDLINE

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Περιγραφή
ISSN:	1590-3478
DOI:	10.1007/s10072-026-09375-9