Paired comparison of extrinsic feedback effects on motor learning and functional recovery after stroke: a secondary analysis of randomized controlled trials
In brief
Extrinsic feedback lifts motor learning by one SD, functional recovery unchanged
A meta-analysis of five small trials (149 stroke patients) found that providing extrinsic feedback during practice increased motor-learning scores by roughly one standard deviation, while its effect on functional recovery was not statistically significant. The evidence is low-certainty, so clinicians should still measure both learning and functional outcomes when testing rehabilitation strategies.
- Journal
- Disability and rehabilitation (Q1)
- Published
- 4 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Ivana Bardino Novosel, Jan Christensen, Jakob Lorentzen
- PMID
- 42695524
- DOI
- 10.1080/09638288.2026.2726997
Why clinicians should know about it
- Picked for Rehabilitation (top studies of the week, 6 September 2026): EF effects on motor learning vs functional recovery post‑stroke
Abstract
INTRODUCTION: 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. OBJECTIVE: To directly compare EF effects on motor learning and functional recovery after stroke. METHODS: 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. RESULTS: 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; p > 0.43). CONCLUSIONS: 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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.