Verum versus Sham brain-computer interface on upper limb function recovery after stroke: A systematic review and meta-analysis of randomized controlled trials

Abstract

Background: Previous clinical trials have reported that the brain-computer interface (BCI) is a useful management tool for upper limb function recovery (ULFR) in stroke. However, there is insufficient evidence regarding this topic. Thus, this study aimed to investigate the effectiveness of verum versus sham BCI on the ULFR in stroke patients. Methods: We comprehensively searched the Cochrane Library, PUBMED, EMBASE, Web of Science, and China National Knowledge Infrastructure databases from their inception to January 1, 2023. Randomized clinical trials (RCTs) assessing the effectiveness and safety of BCI for ULFR after stroke were included. The outcomes were the Fugl-Meyer Assessment for Upper Extremity, Wolf Motor Function Test, Modified Barthel Index, motor activity log, and Action Research Arm Test. The methodological quality of all the included randomized controlled trials was evaluated using the Cochrane risk-of-bias tool. Statistical analysis was performed using RevMan 5.4 software. Results: Eleven eligible studies involving 334 patients were included. The results of the meta-analysis showed significant differences in the Fugl-Meyer Assessment for Upper Extremity (mean difference [MD] = 4.78, 95% confidence interval [CI] [1.90, 7.65], I2= 0%, P =.001) and Modified Barthel Index (MD = 7.37, 95% CI [1.89, 12.84], I2= 19%, P =.008). However, no significant differences were found on motor activity log (MD = -0.70, 95% CI [-3.17, 1.77]), Action Research Arm Test (MD = 3.05, 95% CI [-8.33, 14.44], I2= 0%, P =.60), and Wolf Motor Function Test (MD = 4.23, 95% CI [-0.55, 9.01], P =.08). Conclusion: BCI may be an effective management strategy for ULFR in stroke patients. Future studies with larger sample size and strict design are still needed to warrant the current findings.