Abstract
BACKGROUND: To compare the effects of different rehabilitation therapies on the scores of Fugl-Meyer assessment of motor recovery (FMA), the action research arm test (ARAT), and modified Barthel index in hemiplegic patients with stroke by a network meta-analysis. METHODS: We searched Embase, PubMed, Web of Science, and Cochrane Library from their inception until April 1, 2024 for randomized controlled trials (RCTs) on the effects of rehabilitation therapies on upper extremity motor function and activities of daily living in hemiplegic patients with stroke. Data analyses were conducted using R software. RESULTS: Seventeen RCTs were included, involving 901 patients and 10 rehabilitation therapies. The network meta-analysis revealed that mirror therapy (mean difference [MD] = 4.94, 95% confidence interval [CI]: 4.3-5.59, P < .05), neuromuscular electrical stimulation (NMES) + robotic therapy (RT) (MD = 7.1, 95% CI: 3.15-11.10, P < .05), RT (MD = 4.7, 95% CI: 0.98-8.41, P < .05), and transcranial direct current stimulation (MD = -4.92, 95% CI: -6.12 to -3.72, P < .05) outperformed conventional therapies in the improvement of FMA. NMES + RT (MD = 4.6, 95% CI: 0.42-8.76, P < .05) and repetitive facilitative exercise (RFE) + botulinum toxin type A (BoNT-A) (MD = 8, 95% CI: 4.43-11.52, P < .05) outperformed conventional therapies in the improvement of ARAT. Action observation (AO) (MD = 6, 95% CI: 0.11-11.85, P < .05) was superior to conventional therapies in the improvement of activities of daily living. RFE + BoNT-A had the highest surface under the cumulative ranking curve value for FMA improvement and ARAT improvement. The surface under the cumulative ranking curve value for modified Barthel index improvement was the highest for AO. CONCLUSION: RFE + BoNT-A and AO exhibit advantages in improving upper extremity motor function and AO, respectively. Due to some limitations in this study, more high-quality RCTs are still required to validate our findings.