Effectiveness of brain-computer interface rehabilitation in stroke patients: A meta-analysis and restricted cubic spline analysis of randomized controlled trials

Despite growing evidence supporting the benefits of brain-computer interface (BCI) rehabilitation in post-stroke motor recovery, this review aimed to evaluate its efficacy and determine optimal training intensity. Systematic searches were conducted across Medline, EMBASE and Web of Science from January 1, 1990, to January 30, 2026, to identify relevant RCTs. A random- or fixed-effects model was used to pool outcome data. The restricted cubic spline (RCS) method was applied to estimate the dose-response relationship between BCI training intensity and upper extremity motor function. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Twenty-six studies, encompassing 1100 stroke patients, were included in this meta-analysis. The number of studies and participants varied across outcomes. Compared with control interventions, BCI-based rehabilitation demonstrated significant improvement in FMA-UE (24 studies, 1042 participants; MD = 1.11, 95% CI = 0.63 to 1.60), ARAT (8 studies, 524 participants; MD = 0.21, 95% CI = 0.04 to 0.39), WMFT (5 studies, 425 participants; MD = 0.94, 95% CI = 0.32 to 1.55), MBI (4 studies, 153 participants; MD = 1.17, 95% CI = 0.29 to 2.06), and BBS (2 studies, 35 participants; MD = 0.54, 95% CI = 0.02 to 1.07), but not in FMA-LE (2 studies, 78 participants; MD = -0.12, 95% CI = -0.79 to 0.55) or TUGT (2 studies, 35 participants; MD = -0.40, 95% CI = -1.15 to 0.34). Dose-response analysis suggested a non-linear, inverted U-shaped relationship between BCI rehabilitation intensity and FMA-UE, with the peak effect estimated at approximately 48 min per session. BCI-based rehabilitation may be an effective therapeutic strategy for enhancing upper-extremity motor recovery in post-stroke patients, and this review further suggests a potential optimal session duration of approximately 48 min based on dose-response analysis. However, its efficacy for lower-extremity motor recovery remains inconclusive and warrants further investigation.