{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T23:13:55Z","timestamp":1764890035855,"version":"3.46.0"},"reference-count":46,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000},"content-version":"unspecified","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Key R&D Program of China","award":["2023YFC3603800","2023YFC3603802"],"award-info":[{"award-number":["2023YFC3603800","2023YFC3603802"]}]},{"name":"Sichuan Science and Technology Program","award":["2024NSFSC0539"],"award-info":[{"award-number":["2024NSFSC0539"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,9,19]]},"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Stroke is the second leading cause of death and disability creating a huge economic burden annually. Robot-assisted training (RT) is a promising therapy in stroke rehabilitation, but for the elderly, traditional \u2018reaching objects\u2019\u201d tasks do not seem to create sufficient motivation, an important factor in rehabilitation, which reduces the effect of rehabilitation. Combining RT with some popular card games like mahjong, a popular tiled-based game in the Chinese elderly, is a strategy to motivate stroke survivors. Combining functional near-infrared imaging spectroscopy technique (fNIRS), the aim of this trial is to explore the effects of mahjong-based RT on stroke survivors compared with traditional RT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>The three-arm, assessor-blinded, randomised controlled trial will allocate 18 participants in each group, traditional robot-assisted training (TRT) group, mahjong game-based upper limb robot-assisted training (MULR) group and conventional rehabilitation group. Participants in these three groups will receive 30-min physical therapy and 30-min occupational therapy 5\u2009days per week for 3 weeks. Participants in the TRT group will receive an extra 30-min TRT, while participants in the MULR group will receive an extra 30-min MULR 5\u2009days per week for 3 weeks. The primary outcome will be the neuromuscular function of upper limb assessed by Fugl-Meyer Assessment of Upper Extremity assessed at baseline and after the last treatment has been completed. Other outcomes will include cognitive function assessed by Montreal Cognitive Assessment, rehabilitation motivation assessed by Pittsburgh Rehabilitation Participation Scale, activities of daily living assessed by Modified Barthel Index, emotion assessed by self-rating anxiety scale and self-rating depression scale) and brain neural activity assessed by fNIRS. Two-way analysis of variance, Welch\u2019s ANOVA, post hoc comparison and simple effects analyses will be used for the analysis of scale data; while generalisation linear model analysis and seed-based correlation will be used for the analysis of fNIRS data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This trial was approved by the ethics committee of the West China Hospital of Sichuan University, China (reference number: 2024298). The results of this trial will be published in peer-reviewed scientific journals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      This trial has been registered on the Chinese Clinical Trial Registry,\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.chictr.org.cn\">https:\/\/www.chictr.org.cn<\/jats:ext-link>\n                      . The reference number is ChiCTR2400084049. The registered name is \u2018Effect of mahjong game-based upper limb robot training on upper limb function in stroke patients: a functional near-infrared clinical study protocol\u2019.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-093174","type":"journal-article","created":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T10:50:26Z","timestamp":1760093426000},"page":"e093174","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of mahjong, a Chinese tiled-based game, combined with upper limb robot training on upper limb function and rehabilitation participation in Chinese stroke patients: a clinical trial protocol"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3825-3971","authenticated-orcid":false,"given":"Yang","family":"Xu","sequence":"first","affiliation":[{"name":"Rehabilitation Medicine Center and Institute of 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