Effects of brain-computer interface-based training on post-stroke lower limb rehabilitation: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND

Lower-limb motor dysfunction after stroke severely compromises mobility and quality of life. Brain-computer interface (BCI) technology, which employs a "central-peripheral-central" closed-loop to promote neuroplasticity, offers a promising rehabilitation approach. However, its optimal dosing parameters remain unclear.

OBJECTIVE

This study aimed to evaluate the efficacy of BCI-based training on lower-limb motor function, balance, walking capacity, and activities of daily living (ADL) after stroke, and to explore the impact of total training dose, session duration, and stroke phase.

METHODS

We systematically searched major databases for randomized controlled trials (RCTs) published up to April 2026. All included studies were RCTs. Methodological quality was assessed using the PEDro scale. A meta-analysis was conducted using RevMan 5.4 to calculate mean differences (MD) and 95% confidence intervals (CI).

RESULTS

Ten RCTs involving 366 participants were included. BCI training significantly improved lower-limb motor function (Fugl-Meyer Assessment for Lower Extremity: MD = 2.38, 95% CI 1.72 to 3.04, P < 0.00001). Although this mean difference is below the anchor-based Minimal Clinically Important Difference (MCID) of 6 points reported for chronic stroke populations, it represents a statistically robust and consistent improvement across RCTs, suggesting potential clinical relevance, particularly in subacute patients or specific intervention subgroups.

CONCLUSIONS

BCI-based training effectively improves lower-limb motor recovery after stroke. Subgroup analyses suggested that a moderate total dose (401-800 minutes) combined with 20-40-minute sessions may represent a potentially optimal regimen, although these findings are based on limited RCTs and require confirmation in larger studies.