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This systematic review with meta-analysis evaluated the impact of different EMG-based rehabilitation approaches compared with non-EMG-based interventions in individuals with stroke. Seven databases were searched from inception to November 17, 2025, in accordance with PRISMA guidelines. Randomized controlled trials comparing EMG-based and non-EMG-based interventions for post-stroke hand or wrist rehabilitation were eligible. Interventions were classified into four categories: EMG-triggered electrical stimulation (EMG-ES), EMG-ES combined with other interventions, EMG-based robotic platforms, and EMG biofeedback combined with other interventions. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Meta-analyses were conducted for clinical outcomes classified according to the International Classification of Functioning, Disability and Health (ICF) domains at post-intervention, follow-up &lt;3 months, and follow-up \u22653 months. Thirty-eight studies involving 1,132 participants were included, of which 31 contributed to the meta-analyses. Eight studies were judged to have a low risk of bias, 13 to have some concerns, and 17 to have a high risk of bias. EMG-ES alone was not superior to conventional therapy. In contrast, EMG-ES combined with other interventions produced greater improvements across all ICF domains. EMG-based robotic platforms reduced wrist and finger spasticity, with effects sustained at long-term follow-up. EMG biofeedback primarily improved outcomes within the ICF body functions and structures domain. The effectiveness of EMG-based interventions depends on the rehabilitation strategy. EMG-ES, combined with other therapies, may be prioritized, whereas EMG-based robotic platforms may be useful in reducing spasticity. Further high-quality studies are needed to establish the clinical effectiveness of EMG-biofeedback approaches.<\/jats:p>\n                  <jats:p>\n                    <jats:bold>Graphical abstract<\/jats:bold>\n                  <\/jats:p>\n                  <jats:p>The graphical abstract summarizes the findings of a systematic review and meta-analysis including 38 studies and 1,132 participants. Four types of sEMG-based rehabilitation interfaces were examined across the International Classification of Functioning, Disability and Health (ICF) domains of Body Functions and Structures, Activity, Participation, and Patient-reported outcomes. The symbols indicate the direction of the observed effects and the certainty of the evidence according to GRADE. The results suggest that the effects of sEMG-based rehabilitation vary according to the type of interface. The combination of sEMG-triggered electrical stimulation with other interventions produced the most consistent improvements across the ICF domains. In contrast, sEMG-triggered stimulation alone and sEMG-biofeedback combined with other interventions showed fewer and less consistent benefits. sEMG-based robotic platforms also showed potential, particularly for reducing spasticity. Together, these findings favor the use of combined sEMG-triggered interventions while supporting further investigation of sEMG-based robotic approaches in rehabilitation.<\/jats:p>","DOI":"10.1007\/s11517-026-03660-7","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T08:34:07Z","timestamp":1787906047000},"page":"3675-3701","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of EMG-based interfaces for hand motor rehabilitation in stroke: A systematic review with evidence gap map and meta-analysis"],"prefix":"10.1007","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1019-9423","authenticated-orcid":false,"given":"Cristian D.","family":"Guerrero-Mendez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8502-0032","authenticated-orcid":false,"given":"Natanael Pereira","family":"Batista","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8471-8594","authenticated-orcid":false,"given":"Jos\u00e9 Osmar","family":"Alves Filho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7323-3767","authenticated-orcid":false,"given":"Carina Marconi","family":"Germer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4488-3063","authenticated-orcid":false,"given":"Leonardo Abdala","family":"Elias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"issue":"2","key":"3660_CR1","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1177\/17474930241308142","volume":"20","author":"VL Feigin","year":"2025","unstructured":"Feigin VL, Brainin M, Norrving B, Martins SO, Pandian J, Lindsay P et al (2025) World stroke organization: global stroke fact sheet 2025. 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