Examining the effectiveness of motor imagery combined with non-invasive brain stimulation for upper limb recovery in stroke patients: a systematic review and meta-analysis of randomized clinical trials.

Only Asian studies were included, which may limit how well the results apply to other populations. Blinding was inconsistent: in many trials, participants and therapists knew which treatment was given, and some studies did not blind outcome assessors. The result for activities of daily living had high heterogeneity, meaning the studies varied too much for a reliable pooled estimate. Routine rehabilitation varied across the included trials, so it is unclear how much of the effect came from the combined intervention versus usual care. Only five studies reported follow-up data, and the intervention periods were short (two to four weeks), limiting conclusions about long-term benefit. The number of studies reporting neurophysiological outcomes was small, and equipment varied, making those results difficult to interpret.

The work was funded by the Hebei Province Medical Applicable Technology Tracking Project. The paper does not report any author disclosures.

Do not assume the combined therapy produces lasting recovery. The advantage over single therapy disappeared by four weeks after treatment ended in the studies that followed patients up, and the benefit was absent in chronic stroke survivors.