The effect of extrinsic feedback on improving functioning in people with congenital and acquired brain injury: a systematic review and meta-analysis

Estimating the effect of extrinsic feedback (EF) on functional recovery, functional skill acquisition, and motor learning in individuals with brain injuries. Systematic review and meta-analysis using databases MEDLINE, EMBASE, PEDro, and Cochrane Central Register of Controlled Trials searched on January 2024. Eligible trials compared motor training with EF provision to no EF provision or with different EF content. Two reviewers independently screened, extracted data, and assessed the risk of bias. Random effects meta-analysis synthesized the results. The certainty of evidence was rated using the GRADE approach. 51 controlled trials, including 1,451 participants. No significant EF effect for children and teenagers with cerebral palsy (CP). Among adults with stroke, EF showed a large effect on functional recovery (SMD 1.03, 95% CI [0.13; 1.93]) and a moderate effect on motor learning (SMD 0.52, 95% CI [0.35; 0.69]). High to moderate evidence for a large to moderate effect of EF on functional recovery and motor learning in adults with stroke. Effectiveness for children, adolescents, and adults with congenital and traumatic brain injury lacks evidence. Comprehensive meta-analytic synthesis of different EF content was not possible. PROSPERO CRD42022327646. Extrinsic feedback provision significantly improves functional recovery and motor learning in individuals with stroke.The effectiveness of extrinsic feedback for individuals with cerebral palsy and traumatic brain injury is uncertain due to low sample size and other methodological issuesThe most effective content of extrinsic feedback remains unclear.We provide a mapping of possible content that can be used to tailor extrinsic feedback to meet individual patient needs. Extrinsic feedback provision significantly improves functional recovery and motor learning in individuals with stroke. The effectiveness of extrinsic feedback for individuals with cerebral palsy and traumatic brain injury is uncertain due to low sample size and other methodological issues The most effective content of extrinsic feedback remains unclear. We provide a mapping of possible content that can be used to tailor extrinsic feedback to meet individual patient needs.