Combined action observation and motor imagery practice for upper limb recovery following stroke: a systematic review and meta-analysis
IntroductionOptimal upper limb recovery requires high-dose physiotherapy; however, this essential component of rehabilitation is under-delivered. Mental practice represents an accessible and cost-effective adjunct to conventional therapy. We therefore evaluated the efficacy of an enhanced mental pra...
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Frontiers Media S.A.
2025-07-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2025.1567421/full |
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| author | Dan Lin Daniel Lloyd Eaves John Derek Franklin Jonathan Richard Robinson Jack Aaron Binks Jonathan Reyes Emerson |
| author_facet | Dan Lin Daniel Lloyd Eaves John Derek Franklin Jonathan Richard Robinson Jack Aaron Binks Jonathan Reyes Emerson |
| author_sort | Dan Lin |
| collection | DOAJ |
| description | IntroductionOptimal upper limb recovery requires high-dose physiotherapy; however, this essential component of rehabilitation is under-delivered. Mental practice represents an accessible and cost-effective adjunct to conventional therapy. We therefore evaluated the efficacy of an enhanced mental practice treatment (combined action observation and motor imagery, AO + MI) for promoting upper limb recovery post stroke.MethodsSearching 10 databases, we identified 18 eligible studies (N = 336), comprising nine randomized controlled trials (RCTs) and nine non-randomized controlled trials (non-RCTs). RCTs were meta-analyzed using upper limb function outcomes (Fugl-Meyer Assessment for upper extremity, FMA-UE; Action Research Arm Test, ARAT). Non-RCTs (not eligible for meta-analysis) were narratively synthesized using upper limb and neuroimaging outcomes.ResultsSeven RCTs reported FMA-UE scores (n = 189), where the standardized mean difference (SMD) for AO + MI treatments was moderate (SMD = 0.58, 95%CI: 0.13–1.04, p = 0.02). Two additional RCTs reported ARAT scores. Meta-analyzing the combined FMA-UE and ARAT scores (n = 239) revealed SMD = 0.70 (95%CI: 0.32–1.09, p = 0.003). No significant correlations existed between the pooled effect size and several moderators (age, time since stroke, intervention duration, control condition, outcome measure and AO + MI arrangement), indicating consistent AO + MI practice effects. Overall, AO + MI significantly improved upper limb function across all nine RCTs, and all nine narratively synthesized studies, including neuroimaging outcomes. Limitations included inconsistent terminology, intervention design, clarity of reporting, and modality.DiscussionAO + MI practice can promote upper limb recovery following stroke. AO + MI can therefore be used as a bridge between AO therapy (requiring little effort in early recovery), and the more cognitively demanding MI. Researchers must adopt standardized reporting protocols to further establish AO + MI practice efficacy.Systematic review registrationThe review was registered with PROSPERO under the registration number CRD42023418370. The registration is publicly accessible at the following URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023418370. |
| format | Article |
| id | doaj-art-43d7eaa935f346a0bb804cc3ad13635a |
| institution | Kabale University |
| issn | 1664-2295 |
| language | English |
| publishDate | 2025-07-01 |
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| series | Frontiers in Neurology |
| spelling | doaj-art-43d7eaa935f346a0bb804cc3ad13635a2025-08-20T03:31:42ZengFrontiers Media S.A.Frontiers in Neurology1664-22952025-07-011610.3389/fneur.2025.15674211567421Combined action observation and motor imagery practice for upper limb recovery following stroke: a systematic review and meta-analysisDan Lin0Daniel Lloyd Eaves1John Derek Franklin2Jonathan Richard Robinson3Jack Aaron Binks4Jonathan Reyes Emerson5School of Health and Life Sciences, Teesside University, Middlesbrough, United KingdomBiomedical, Nutritional and Sport Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle, United KingdomSchool of Health and Life Sciences, Teesside University, Middlesbrough, United KingdomSchool of Health and Life Sciences, Teesside University, Middlesbrough, United KingdomPopulation Health Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle, United KingdomKleijnen Systematic Reviews (KSR) Ltd, York, United KingdomIntroductionOptimal upper limb recovery requires high-dose physiotherapy; however, this essential component of rehabilitation is under-delivered. Mental practice represents an accessible and cost-effective adjunct to conventional therapy. We therefore evaluated the efficacy of an enhanced mental practice treatment (combined action observation and motor imagery, AO + MI) for promoting upper limb recovery post stroke.MethodsSearching 10 databases, we identified 18 eligible studies (N = 336), comprising nine randomized controlled trials (RCTs) and nine non-randomized controlled trials (non-RCTs). RCTs were meta-analyzed using upper limb function outcomes (Fugl-Meyer Assessment for upper extremity, FMA-UE; Action Research Arm Test, ARAT). Non-RCTs (not eligible for meta-analysis) were narratively synthesized using upper limb and neuroimaging outcomes.ResultsSeven RCTs reported FMA-UE scores (n = 189), where the standardized mean difference (SMD) for AO + MI treatments was moderate (SMD = 0.58, 95%CI: 0.13–1.04, p = 0.02). Two additional RCTs reported ARAT scores. Meta-analyzing the combined FMA-UE and ARAT scores (n = 239) revealed SMD = 0.70 (95%CI: 0.32–1.09, p = 0.003). No significant correlations existed between the pooled effect size and several moderators (age, time since stroke, intervention duration, control condition, outcome measure and AO + MI arrangement), indicating consistent AO + MI practice effects. Overall, AO + MI significantly improved upper limb function across all nine RCTs, and all nine narratively synthesized studies, including neuroimaging outcomes. Limitations included inconsistent terminology, intervention design, clarity of reporting, and modality.DiscussionAO + MI practice can promote upper limb recovery following stroke. AO + MI can therefore be used as a bridge between AO therapy (requiring little effort in early recovery), and the more cognitively demanding MI. Researchers must adopt standardized reporting protocols to further establish AO + MI practice efficacy.Systematic review registrationThe review was registered with PROSPERO under the registration number CRD42023418370. The registration is publicly accessible at the following URL: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023418370.https://www.frontiersin.org/articles/10.3389/fneur.2025.1567421/fullcombined action observation and motor imagerymental practicestroke survivorsstroke rehabilitationupper limb recoverymirror neurons |
| spellingShingle | Dan Lin Daniel Lloyd Eaves John Derek Franklin Jonathan Richard Robinson Jack Aaron Binks Jonathan Reyes Emerson Combined action observation and motor imagery practice for upper limb recovery following stroke: a systematic review and meta-analysis Frontiers in Neurology combined action observation and motor imagery mental practice stroke survivors stroke rehabilitation upper limb recovery mirror neurons |
| title | Combined action observation and motor imagery practice for upper limb recovery following stroke: a systematic review and meta-analysis |
| title_full | Combined action observation and motor imagery practice for upper limb recovery following stroke: a systematic review and meta-analysis |
| title_fullStr | Combined action observation and motor imagery practice for upper limb recovery following stroke: a systematic review and meta-analysis |
| title_full_unstemmed | Combined action observation and motor imagery practice for upper limb recovery following stroke: a systematic review and meta-analysis |
| title_short | Combined action observation and motor imagery practice for upper limb recovery following stroke: a systematic review and meta-analysis |
| title_sort | combined action observation and motor imagery practice for upper limb recovery following stroke a systematic review and meta analysis |
| topic | combined action observation and motor imagery mental practice stroke survivors stroke rehabilitation upper limb recovery mirror neurons |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2025.1567421/full |
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