Integrating electromyographic biofeedback in stroke rehabilitation: A paradigm shift in motor and psychological recovery

Table 1 Pooled efficacy of electromyographic biofeedback in stroke rehabilitation (k = 15 studies, n = 1850)

Outcome measure	EMG biofeedback + conventional therapy (d)	Conventional therapy alone (d)	P value
FMA-UL	0.82 (0.71-0.93)	0.45 (0.34-0.56)	< 0.001
FMA-LL	0.79 (0.68-0.90)	0.41 (0.30-0.52)	< 0.001
HAMA	-0.75 (-0.86 to -0.64)	-0.30 (-0.41 to -0.19)	< 0.001
HAMD	-0.71 (-0.82 to -0.60)	-0.28 (-0.39 to -0.17)	< 0.001
Berg Balance Scale	0.69 (0.58-0.80)	0.33 (0.22-0.44)	< 0.001

The uniform P < 0.001 reflect consistent statistical significance across outcomes in pooled analyses but may simplify individual study variations. Some trials reported moderate or non-significant effects, particularly in subgroups with severe stroke or comorbidities. FMA-UL: Fugl-Meyer Assessment upper limb; FMA-LL: Fugl-Meyer Assessment lower limb; HAMA: Hamilton Anxiety Rating Scale; HAMD: Hamilton Depression Rating Scale; EMG: Electromyographic.

Table 2 Implementation framework for electromyographic biofeedback in stroke rehabilitation

Domain	Recommendation	Evidence level
Session frequency	3-5 sessions/week for 8 weeks	Meta-analysis (k = 10)
Duration per session	30-45 minutes	RCT (n = 300)
Muscle groups	Focus on agonist-antagonist pairs (e.g., wrist flexors/extensors)	Systematic review
Psychological support	Combine with mindfulness or CBT	Yu et al[2]

CBT: Cognitive behavioral therapy; RCT: Randomized controlled trial.