Paired comparison of extrinsic feedback effects on motor learning and functional recovery after stroke: a secondary analysis of randomized controlled trials.

Abstract

Extrinsic feedback (EF) provides external signals during motor practice to enhance knowledge of performance or results. While EF can improve outcomes after stroke, its relative effects on motor learning versus functional recovery remain unclear. To directly compare EF effects on motor learning and functional recovery after stroke. We conducted a secondary analysis of controlled trials from a previous systematic review, updated through November 2025. Trials reporting both motor learning and functional recovery were included. Standardized mean differences (SMDs) were calculated using random-effects meta-analysis. Multivariate meta-analysis accounted for within-study dependence, with analyses varying assumed correlations (ρ = 0.3, 0.5, 0.7). Risk of bias was assessed using ROB2, and certainty of the evidence with GRADE. Five trials (149 participants) were included. EF significantly improved motor learning (SMD 1.19; 95% CI 0.16-2.22; low-certainty). Effects on functional recovery were not significant (SMD 1.00; 95% CI -0.42-2.42; very low-certainty). Multivariate meta-analysis detected no statistical difference between outcomes (ΔSMD 0.19-0.23; <i>p</i> > 0.43). No significant difference between outcomes, though uncertainty is substantial due to small sample size and imprecision. Motor learning gains may not generalize to functional recovery, supporting the value of assessing both outcomes in stroke rehabilitation trials.