{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T19:18:01Z","timestamp":1787944681482,"version":"build-2784847793"},"reference-count":142,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Noninvasive brain-computer interface (BCI)\u2013based interventions show promise for poststroke motor recovery. However, the intrinsic complexity of BCI-based interventions limits the determination of their comparative efficacy.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n Guided by the International Classification of Functioning, Disability and Health framework, this review evaluated the effectiveness of BCI-based interventions in poststroke upper limb rehabilitation and identify the optimal intervention.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We searched PubMed, Cochrane Library, EBSCOhost, Web of Science, Embase, Wiley Online Library,CNKI, Wanfang, VIP, and SinoMed through July 2026. Randomized controlled trials (RCTs) assessing BCI-based interventions for poststroke upper limb rehabilitation were included. Outcomes were body functions and structures (Fugl-Meyer Assessment of Upper Extremity [FMA-UE]) and activities and participation (Action Research Arm Test [ARAT], Wolf Motor Function Test [WMFT], and Modified Barthel Index [MBI]). Risk of bias was assessed using Cochrane RoB 2, and evidence quality was graded using the Grading of Recommendations, Assessment, Development, and Evaluation framework. We used pairwise meta-analyses to evaluate the overall effectiveness of BCI-based interventions vs controls and network meta-analysis to compare the interventions.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Seventy-two RCTs involving 2906 patients with stroke were included, evaluating 12 BCI-based interventions. Pairwise meta-analyses demonstrated that, compared with control groups, BCI-based interventions improved FMA-UE (mean difference [MD] 5.33, 95% CI 4.28 to 6.38; 95% prediction interval [PI] \u22121.76 to 12.43), ARAT (MD 5.26, 95% CI 3.90 to 6.62; 95% PI 0.41 to 10.11), WMFT (MD 7.25, 95% CI 5.06 to 9.44; 95% PI 0.71 to 13.79), and MBI (MD 8.18, 95% CI 6.04 to 10.32; 95% PI \u22121.87 to 18.23). Network meta-analysis revealed that BCI-motor imagery-transcutaneous electrical acupoint stimulation (BCI-MI-TEAS) achieved the highest surface under the cumulative ranking curve (SUCRA; 95.5%) in improving FMA-UE. For ARAT, BCI-MI\u2013end-effector robots and transcranial direct current stimulation (tDCS; 86.3%) alongside BCI-MI-TEAS (86.3%) yielded the highest SUCRA. BCI-MI\u2013exoskeleton robot showed the highest SUCRA for WMFT (92.7%), whereas BCI-MI-TEAS (85.3%) and BCI-MI\u2013exoskeleton robot (81.7%) ranked highest for MBI. The evidence quality ranged from very low to high across these interventions.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This study represents the first network meta-analysis comparing the efficacy of different BCI-based interventions. Unlike previous reviews, interventions were categorized by experimental paradigms, external feedback devices, and adjunctive noninvasive brain stimulation, to enable clinically meaningful comparisons. Overall, BCI-based interventions significantly improved poststroke upper limb rehabilitation. Among evaluated interventions, BCI-MI-TEAS demonstrated the most performance across body functions, structures, and activities and participation, whereas BCI-MI\u2013end-effector robot + tDCS showed advantages for fine motor dexterity and BCI-MI\u2013exoskeleton robot improved activities of daily living.Given low to moderate evidence certainty and substantial heterogeneity, these findings remain exploratory. High-quality trials are needed to establish the clinical utility of these interventions.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/92940","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T18:46:22Z","timestamp":1787942782000},"page":"e92940-e92940","source":"Crossref","is-referenced-by-count":0,"title":["Comparative Effectiveness of Noninvasive Brain-Computer Interface\u2013Based Interventions for Upper Limb Rehabilitation in Poststroke Hemiplegia: Systematic Review and Network Meta-Analysis of Randomized Controlled 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