Motor imagery for post-stroke upper limb recovery: a meta-analysis of RCTs on Fugl-Meyer upper extremity scores

[ENG]Objectives: Motor imagery (MI) may enhance post-stroke recovery, but evidence of its benefit over conventional rehabilitation therapy (CRT) is inconsistent. This study evaluated the effect of MI combined with CRT on upper-limb recovery, accounting for methodological quality and publication bias...

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Autores: Polo Ferrero, Luis, Torres Alonso, Javier, Sánchez González, Juan Luis, Hernández Rubia, Sara, Pérez Elvira, Rubén, Oltra Cucarella, Javier
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2025
País:España
Institución:Universidad de Salamanca (USAL)
Repositorio:GREDOS. Repositorio Institucional de la Universidad de Salamanca
OAI Identifier:oai:gredos.usal.es:10366/170718
Acceso en línea:http://hdl.handle.net/10366/170718
Access Level:acceso abierto
Palabra clave:Fugl-Meyer
meta-analysis
motor imagery
neurorehabilitation
stroke
upper-limb recovery
Meta-Analysis
Stroke
accidente cerebrovascular
metanálisis
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spelling Motor imagery for post-stroke upper limb recovery: a meta-analysis of RCTs on Fugl-Meyer upper extremity scoresPolo Ferrero, LuisTorres Alonso, JavierSánchez González, Juan LuisHernández Rubia, SaraPérez Elvira, RubénOltra Cucarella, JavierFugl-Meyermeta-analysismotor imageryneurorehabilitationstrokeupper-limb recoveryMeta-AnalysisStrokeaccidente cerebrovascularmetanálisis[ENG]Objectives: Motor imagery (MI) may enhance post-stroke recovery, but evidence of its benefit over conventional rehabilitation therapy (CRT) is inconsistent. This study evaluated the effect of MI combined with CRT on upper-limb recovery, accounting for methodological quality and publication bias. Methods: A systematic review and meta-analysis was conducted following PRISMA guidelines. Searches were performed in multiple databases up to July 2025. Methodological quality and risk of bias were assessed using the PEDro scale and Cochrane RoB 2 tool, respectively. Analyses included the calculation of effect sizes (ES), heterogeneity, sensitivity, publication bias, and GRADE-based certainty assessment. Results: From 4074 records, 10 randomized controlled trials (n = 255) were included. The initial pooled analysis showed a small-to-moderate effect of MI + CRT versus CRT alone (ES = 0.45; 95% CI: 0.16-0.74). However, the overall ES calculated with a robust variance estimator was -0.06 (95% CI: -0.21, 0.08). Most trials had methodological limitations (mean PEDro = 6.0; high risk of bias in 7/10 studies). The GRADE evaluation indicated a very low certainty of evidence. Conclusions: The initially observed positive effect of MI combined with CRT is not robust. When accounting for statistical dependencies and potential biases, the effect vanishes and is no different from zero. Current evidence does not support the use of MI as a standalone adjunct to CRT. Larger, high-quality RCTs with standardized protocols are required to establish any potential clinical relevance.https://www.mdpi.com/2077-0383/14/21/7891202620262025info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://hdl.handle.net/10366/170718reponame:GREDOS. Repositorio Institucional de la Universidad de Salamancainstname:Universidad de Salamanca (USAL)InglésAttribution-NonCommercial-NoDerivatives 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:gredos.usal.es:10366/1707182026-06-07T06:28:51Z
dc.title.none.fl_str_mv Motor imagery for post-stroke upper limb recovery: a meta-analysis of RCTs on Fugl-Meyer upper extremity scores
title Motor imagery for post-stroke upper limb recovery: a meta-analysis of RCTs on Fugl-Meyer upper extremity scores
spellingShingle Motor imagery for post-stroke upper limb recovery: a meta-analysis of RCTs on Fugl-Meyer upper extremity scores
Polo Ferrero, Luis
Fugl-Meyer
meta-analysis
motor imagery
neurorehabilitation
stroke
upper-limb recovery
Meta-Analysis
Stroke
accidente cerebrovascular
metanálisis
title_short Motor imagery for post-stroke upper limb recovery: a meta-analysis of RCTs on Fugl-Meyer upper extremity scores
title_full Motor imagery for post-stroke upper limb recovery: a meta-analysis of RCTs on Fugl-Meyer upper extremity scores
title_fullStr Motor imagery for post-stroke upper limb recovery: a meta-analysis of RCTs on Fugl-Meyer upper extremity scores
title_full_unstemmed Motor imagery for post-stroke upper limb recovery: a meta-analysis of RCTs on Fugl-Meyer upper extremity scores
title_sort Motor imagery for post-stroke upper limb recovery: a meta-analysis of RCTs on Fugl-Meyer upper extremity scores
dc.creator.none.fl_str_mv Polo Ferrero, Luis
Torres Alonso, Javier
Sánchez González, Juan Luis
Hernández Rubia, Sara
Pérez Elvira, Rubén
Oltra Cucarella, Javier
author Polo Ferrero, Luis
author_facet Polo Ferrero, Luis
Torres Alonso, Javier
Sánchez González, Juan Luis
Hernández Rubia, Sara
Pérez Elvira, Rubén
Oltra Cucarella, Javier
author_role author
author2 Torres Alonso, Javier
Sánchez González, Juan Luis
Hernández Rubia, Sara
Pérez Elvira, Rubén
Oltra Cucarella, Javier
author2_role author
author
author
author
author
dc.subject.none.fl_str_mv Fugl-Meyer
meta-analysis
motor imagery
neurorehabilitation
stroke
upper-limb recovery
Meta-Analysis
Stroke
accidente cerebrovascular
metanálisis
topic Fugl-Meyer
meta-analysis
motor imagery
neurorehabilitation
stroke
upper-limb recovery
Meta-Analysis
Stroke
accidente cerebrovascular
metanálisis
description [ENG]Objectives: Motor imagery (MI) may enhance post-stroke recovery, but evidence of its benefit over conventional rehabilitation therapy (CRT) is inconsistent. This study evaluated the effect of MI combined with CRT on upper-limb recovery, accounting for methodological quality and publication bias. Methods: A systematic review and meta-analysis was conducted following PRISMA guidelines. Searches were performed in multiple databases up to July 2025. Methodological quality and risk of bias were assessed using the PEDro scale and Cochrane RoB 2 tool, respectively. Analyses included the calculation of effect sizes (ES), heterogeneity, sensitivity, publication bias, and GRADE-based certainty assessment. Results: From 4074 records, 10 randomized controlled trials (n = 255) were included. The initial pooled analysis showed a small-to-moderate effect of MI + CRT versus CRT alone (ES = 0.45; 95% CI: 0.16-0.74). However, the overall ES calculated with a robust variance estimator was -0.06 (95% CI: -0.21, 0.08). Most trials had methodological limitations (mean PEDro = 6.0; high risk of bias in 7/10 studies). The GRADE evaluation indicated a very low certainty of evidence. Conclusions: The initially observed positive effect of MI combined with CRT is not robust. When accounting for statistical dependencies and potential biases, the effect vanishes and is no different from zero. Current evidence does not support the use of MI as a standalone adjunct to CRT. Larger, high-quality RCTs with standardized protocols are required to establish any potential clinical relevance.
publishDate 2025
dc.date.none.fl_str_mv 2025
2026
2026
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10366/170718
url http://hdl.handle.net/10366/170718
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv Attribution-NonCommercial-NoDerivatives 4.0 Internacional
http://creativecommons.org/licenses/by-nc-nd/4.0/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Attribution-NonCommercial-NoDerivatives 4.0 Internacional
http://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv https://www.mdpi.com/2077-0383/14/21/7891
publisher.none.fl_str_mv https://www.mdpi.com/2077-0383/14/21/7891
dc.source.none.fl_str_mv reponame:GREDOS. Repositorio Institucional de la Universidad de Salamanca
instname:Universidad de Salamanca (USAL)
instname_str Universidad de Salamanca (USAL)
reponame_str GREDOS. Repositorio Institucional de la Universidad de Salamanca
collection GREDOS. Repositorio Institucional de la Universidad de Salamanca
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,811543

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