Motivation in motor training interventions after stroke-a systematic review.

The outcome measures were too different to pool, so the authors counted how many trials pointed in each direction instead of calculating an average. Every trial counts the same however many people it enrolled and whatever it measured. That vote-counting method ignored which measure was the trial's primary one, so a significant subscale counts as much as the main outcome, and a tie was resolved in favour of the intervention. The authors themselves say the results should be read as a trend only. Every included trial was rated at high risk of bias, largely because patients cannot be blinded once they start a game-based or conventional exercise programme. Sample sizes were small, ranging from 11 to 68 people, so the trials had limited power to detect differences. Only the immediate before-and-after results were used. Nothing here tells you whether any benefit lasted once training stopped. Motivation was measured with different questionnaires in different trials, and all measures were self-reported, so trials are not directly comparable and no observer-rated or behavioural measure was included. Interventions lasted at most ten weeks, while rehabilitation in practice often runs for months or years, so the review says nothing about keeping motivation going long term. The search did not include purely psychological databases, so the evidence is framed from a motor rehabilitation point of view.

The authors declared that they received no financial support for this work or for its publication.

Do not read this as evidence that exergames or virtual reality improve motivation or motor recovery after stroke. Only five of 17 trials came out ahead on both, four of those were exergame trials, and every trial was rated at high risk of bias with small samples, so the results were left as counts of direction rather than a pooled effect.