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.

چکیده اصلی

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.

ترجمه فارسی چکیده

هدف این مطالعه مقایسه و رتبه‌بندی اثربخشی درمان‌های مختلف برای بازگشت حرکتی بازو پس از سکته مغزی بود. در این مرور سیستماتیک، ۲۳ گزارش شامل ۷۲۷ شرکت‌کننده بررسی شد. نتایج نشان داد که درمان متصل به رابط مغز-ماشین (BCI-robot) بالاترین امتیاز را در بهبود ارزیابی فولگ-میر (FMA-UE) داشت. این روش نسبت به درمان ربات‌یار و درمان متداول، بهبود معناداری ایجاد کرد، اما اندازه این بهبود برای درمان ربات‌یار کوچک و احتمالاً بالینی مهم نبود. داده‌های مربوط به اثرات طولانی‌مدت و عملکرد روزمره محدود است.

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