Effects of Brain-Computer Interface Combined with Functional Electrical Stimulation on Upper Limb Motor Function of Stroke Patients：A Meta-analysis

<bold>Objective</bold>To evaluate the effect of brain-computer interface (BCI) combined with functional electrical stimulation (FES) technology on upper limb motor function in stroke patients using a Meta-analysis method.<bold>Methods</bold>Data were searched and retrieved from the databases of the China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Chinese Science and Technology Periodical Database (VIP), PubMed, EMbase, Web of Science, The Cochrane Library, ClinicalTrials.gov for randomized controlled trials (RCTs) on BCI-FES improving upper limb motor function in stroke patients from the database inception to February 2025. The primary outcome measures included the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE), FMA-UE score differences, and the Modified Barthel Index (MBI) score. Literature screening, data extraction, and risk of bias assessment were independently performed by two researchers, followed by a meta-analysis using RevMan 5.4 software. Heterogeneity among the included RCTs was assessed using the χ² test and quantified with <italic>I</italic>² to determine the magnitude of heterogeneity. A fixed-effects model was applied when heterogeneity was low (<italic>I</italic>²≤50%, <italic>P</italic>≥0.1); a random-effects model was used when heterogeneity was high (<italic>I</italic>²&gt;50%, <italic>P</italic>&lt;0.1).<bold>Results</bold>A total of 11 RCTs were included, involving 561 participants. Meta-analysis results indicated that compared with the control group, the FMA-UE score in the experimental group after treatment was significantly higher [<italic>MD</italic>=4.04, 95% <italic>CI</italic>(2.59, 5.48), <italic>Z</italic>=5.46, <italic>P</italic>&lt;0.000 01]; and the FMA-UE score difference was significantly higher than that of the control group [<italic>MD</italic>=2.77, 95% <italic>CI</italic>(1.27, 4.28), <italic>Z</italic>=3.61, <italic>P</italic>=0.000 3]; and the MBI score was significantly higher than that of the control group [<italic>MD</italic>=7.41, 95% <italic>CI</italic>(2.47, 12.36), <italic>Z</italic>=2.94, <italic>P</italic>=0.003]. Subgroup analysis results indicated that the post-treatment FMA-UE scores in the experimental group were significantly higher than those in the control group for subgroups stratified by disease stage, first stroke occurrence, and BCI-FES combined with other therapeutic measures after treatment (<italic>P</italic>&lt;0.05). The subgroup FMA-UE score differences in the experimental group were all significantly greater than the control group for disease stage, first stroke occurrence, and BCI-FES combined with other therapeutic measures after treatment (<italic>P</italic>&lt;0.05). The MBI scores in the experimental group were significantly higher than those of the control group for the BCI-FES combined with other therapeutic measures subgroup (<italic>P</italic>&lt;0.05).<bold>Conclusion</bold>BCI-FES technology can effectively improve upper limb motor function and activities of daily living of stroke patients. Better outcomes are achieved when BCI-FES treatment is administered in patients with first-ever stroke, in the early recovery stage of stroke, or combined with other rehabilitation measures.