{
  "abstract": "Electromyography (EMG)-based interventions have been proposed to improve hand/wrist motor recovery after stroke; however, their clinical value remains uncertain, as evidence for their effectiveness is inconsistent. This systematic review with meta-analysis evaluated the impact of different EMG-based rehabilitation approaches compared with non-EMG-based interventions in individuals with stroke. Seven databases were searched from inception to November 17, 2025, in accordance with PRISMA guidelines. Randomized controlled trials comparing EMG-based and non-EMG-based interventions for post-stroke hand or wrist rehabilitation were eligible. Interventions were classified into four categories: EMG-triggered electrical stimulation (EMG-ES), EMG-ES combined with other interventions, EMG-based robotic platforms, and EMG biofeedback combined with other interventions. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Meta-analyses were conducted for clinical outcomes classified according to the International Classification of Functioning, Disability and Health (ICF) domains at post-intervention, follow-up <3 months, and follow-up ≥3 months. Thirty-eight studies involving 1,132 participants were included, of which 31 contributed to the meta-analyses. Eight studies were judged to have a low risk of bias, 13 to have some concerns, and 17 to have a high risk of bias. EMG-ES alone was not superior to conventional therapy. In contrast, EMG-ES combined with other interventions produced greater improvements across all ICF domains. EMG-based robotic platforms reduced wrist and finger spasticity, with effects sustained at long-term follow-up. EMG biofeedback primarily improved outcomes within the ICF body functions and structures domain. The effectiveness of EMG-based interventions depends on the rehabilitation strategy. EMG-ES, combined with other therapies, may be prioritized, whereas EMG-based robotic platforms may be useful in reducing spasticity. Further high-quality studies are needed to establish the clinical effectiveness of EMG-biofeedback approaches.\n\nGraphical abstract: The graphical abstract summarizes the findings of a systematic review and meta-analysis including 38 studies and 1,132 participants. Four types of sEMG-based rehabilitation interfaces were examined across the International Classification of Functioning, Disability and Health (ICF) domains of Body Functions and Structures, Activity, Participation, and Patient-reported outcomes. The symbols indicate the direction of the observed effects and the certainty of the evidence according to GRADE. The results suggest that the effects of sEMG-based rehabilitation vary according to the type of interface. The combination of sEMG-triggered electrical stimulation with other interventions produced the most consistent improvements across the ICF domains. In contrast, sEMG-triggered stimulation alone and sEMG-biofeedback combined with other interventions showed fewer and less consistent benefits. sEMG-based robotic platforms also showed potential, particularly for reducing spasticity. Together, these findings favor the use of combined sEMG-triggered interventions while supporting further investigation of sEMG-based robotic approaches in rehabilitation.\n\nSupplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s11517-026-03660-7.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Electronics and Biomedical Engineering, School of Electrical and Computer Engineering, University of Campinas - UNICAMP, Campinas, 13083-852 SP Brazil",
    "Neural Engineering Research Laboratory, Center for Biomedical Engineering, University of Campinas - UNICAMP, Campinas, 13083-881 SP Brazil",
    "Department of Physical Therapy, Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, Brazil"
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
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        1
      ],
      "name": "Cristian D. Guerrero-Mendez",
      "orcid": "0000-0003-1019-9423"
    },
    {
      "affs": [
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        1,
        2
      ],
      "name": "Natanael Pereira Batista",
      "orcid": "0000-0001-8502-0032"
    },
    {
      "affs": [
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        1
      ],
      "name": "José Osmar Alves Filho",
      "orcid": "0000-0001-8471-8594"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Carina Marconi Germer",
      "orcid": "0000-0002-7323-3767"
    },
    {
      "affs": [
        0,
        1
      ],
      "name": "Leonardo Abdala Elias",
      "orcid": "0000-0003-4488-3063"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5ptaj1v1qfwjk.bib",
  "cited_by": 0,
  "doi": "10.1007/s11517-026-03660-7",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13723694/",
  "id": "5ptaj1v1qfwjk",
  "issns": [
    "0140-0118",
    "1741-0444"
  ],
  "landing_url": "https://doi.org/10.1007/s11517-026-03660-7",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
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  "native_subjects": [
    [
      "heading",
      "Review Article"
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      "openalex",
      "2742|Stroke Rehabilitation and Recovery"
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  "pdf_url": "https://link.springer.com/content/pdf/10.1007/s11517-026-03660-7.pdf",
  "pmcid": "PMC13723694",
  "pmid": "42663910",
  "published": "2026-08-28",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/5ptaj1v1qfwjk.ris",
  "sources": [
    {
      "first_seen": "2026-11-04T12:22:17Z",
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      "url": "https://doi.org/10.1007/s11517-026-03660-7"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2742|Stroke Rehabilitation and Recovery",
      "subfield": "general"
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  "title": "Impact of EMG-based interfaces for hand motor rehabilitation in stroke: A systematic review with evidence gap map and meta-analysis",
  "title_text": "Impact of EMG-based interfaces for hand motor rehabilitation in stroke: A systematic review with evidence gap map and meta-analysis",
  "type": "peer-reviewed",
  "updated_at": "2026-11-05T12:20:28Z",
  "url": "https://research.draconitic.com/paper/5ptaj1v1qfwjk",
  "venue": "Medical & Biological Engineering & Computing",
  "versions": []
}