The impact of non-invasive brain-computer interface technology on the therapeutic effect of patients with spinal cord injury: a summary of evidence based on meta-analysis

The objective of this study is to systematically evaluate the effects of non-invasive brain-computer interface technology on motor and sensory functions and daily living abilities of patients with spinal cord injuries. In addition, the study will investigate the related modifying factors. Ultimately, the study will provide evidence-based recommendations for clinical practice. A systematic search was conducted on PubMed, Web of Science, Scopus, Wiley Online Library, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data Resource System, and VIP Database for relevant literature from database inception to February 2025. The quality of the studies was assessed using Review Manager 5.4, with the risk of bias visually represented. The presence of publication bias was assessed through the utilization of the “metafor” package (version 4.6-0) in R (version 4.4.1). The certainty of the evidence was evaluated using the GRADE framework. A total of 9 papers were included, including 4 randomized controlled trials and 5 self-controlled trials with 109 spinal cord injury patients. Compared with the control group, the non-invasive brain-computer interface intervention had a significant impact on patients’ motor function (SMD = 0.72, 95% CI: [0.35,1.09], P < 0.01, I2 = 0%, medium level of evidence), sensory function (SMD = 0.95, 95% CI: [0.43,1.48], P < 0.01, I2 = 0%, medium level of evidence), activities of daily living (SMD = 0.85, 95% CI: [0.46,1.24], P < 0.01, I2 = 0%, low level of evidence) reached statistical significance. Subgroup analyses showed that for the current summary of evidence, noninvasive brain-computer interface interventions in patients with subacute stage spinal cord injuries showed statistically stronger effects on motor function, sensory function, and ability to perform activities of daily living than in patients with slow chronic stage spinal cord injuries. As far as the existing literature is concerned, non-invasive brain-computer interface technology shows the potential to improve motor and sensory functioning as well as the ability to perform activities of daily living in patients with spinal cord injury. However, the conclusions are preliminary and hypothetical, and as the current evidence for non-invasive BCI interventions for people with spinal cord injury remains limited, this paper does not recommend the application of the conclusions to clinical practice until future large-sample RCTs.