Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 Apr;15(4):e70474.
doi: 10.1002/brb3.70474.

Efficacy of Action Observation Therapy on Cognitive Function in Stroke: A Systematic Review and Meta-Analysis

Xuewei Guan  1 , Meijuan Lan  1 , Leiwen Tang  1 , Hongyan Yang  1 , Yuanyuan Chen  1 , Lan Ge  1 , Yumei Zhong  1
Affiliations
Meta-Analysis

Efficacy of Action Observation Therapy on Cognitive Function in Stroke: A Systematic Review and Meta-Analysis

Xuewei Guan et al. Brain Behav. 2025 Apr.

Abstract

Introduction: Action Observation Therapy (AOT) is a rehabilitation method believed to activate the mirror neuron system, which may contribute to cognitive recovery. Previous studies have shown varying results due to different intervention characteristics. This review will examine the efficacy of AOT on clinical cognitive function in stroke.

Methods: Randomized controlled trials (RCTs) comparing AOT with non-AOT interventions in cognitive function were included. Databases searched included PubMed, Cochrane Library, Embase, Web of Science, EBSCO, CNKI, WanFang, and VIP database from inception to May 6, 2024. The risk of bias was assessed using Cochrane's Risk of Bias Assessment Tool 2.0, and the quality of evidence was evaluated with the GRADE approach. RevMan 5.4 and Stata 18.0 were used for the meta-analysis. After the analysis of cognitive function, meta-regression was performed to explore the possible sources of heterogeneity. A random-effects meta-analysis model using the inverse-variance and Hartung-Knapp methods was used to calculate pooled estimates and 95% confidence interval (CI) values. We examined the funnel plot and used Egger's regression test to assess for publication bias. This study was conducted by PRISMA reporting guidelines (Appendix S1). The search protocol was prospectively registered in PROSPERO (CRD42024571694).

Results: A total of 6 RCTs with 400 participants were included. All the included articles were rated as having B-level quality. Meta-analysis showed that AOT significantly improved cognitive function in stroke. Meta-regression did not find the source of heterogeneity. The GRADE result indicated that the finding was of very low certainty.

Conclusions: Cognitive interventions based on AOT can improve cognitive function in stroke patients. However, it should be interpreted cautiously due to heterogeneity and low certainty. To strengthen evidence-based practices, we advocate for higher-quality and more homogeneous RCTs, including strict randomization procedures, large sample sizes, extended follow-up periods, and studies focused on specific disease subtypes.

Keywords: Action Observation Therapy; cognitive function; meta‐analysis; stroke.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
PRISMA flow diagram of literature screening and selection process.
FIGURE 2
FIGURE 2
The Cochrane risk‐of‐bias assessment for included studies.
FIGURE 3
FIGURE 3
Summary of the Cochrane risk‐of‐bias judgments across all included studies.
FIGURE 4
FIGURE 4
Forest plot of meta‐analysis for cognitive function outcomes.
FIGURE 5
FIGURE 5
Funnel plot assessing publication bias for the meta‐analysis.
FIGURE 6
FIGURE 6
Sensitivity analysis evaluating the robustness of meta‐analysis results.
FIGURE 7
FIGURE 7
Forest plot of sensitivity analysis after exclusion of the study by Wu et al. (2022).
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Blumenfeld, R. S. , and Ranganath C.. 2006. “Dorsolateral Prefrontal Cortex Promotes Long‐Term Memory Formation Through Its Role in Working Memory Organization.” Journal of Neuroscience 26, no. 3: 916–925. 10.1523/JNEUROSCI.2353-05.2006. - DOI - PMC - PubMed
    1. Borges, L. R. , Fernandes A. B., Oliveira Dos Passos J., Rego I. A. O., and Campos T. F.. 2022. “Action Observation for Upper Limb Rehabilitation After Stroke.” Cochrane Database of Systematic Reviews 2022, no. 8: CD011887. 10.1002/14651858.CD011887.pub3. - DOI - PMC - PubMed
    1. Buchignani, B. , Beani E., Pomeroy V., et al. 2019. “Action Observation Training for Rehabilitation in Brain Injuries: A systematic Review and Meta‐Analysis.” BMC Neurology 19, no. 1: 344. 10.1186/s12883-019-1533-x. - DOI - PMC - PubMed
    1. Burton, L. , and Tyson S. F.. 2015. “Screening for Cognitive Impairment After Stroke: A Systematic Review of Psychometric Properties and Clinical Utility.” Journal of Rehabilitation Medicine 47, no. 3: 193–203. 10.2340/16501977-1930. - DOI - PubMed
    1. Carey, L. , Walsh A., Adikari A., et al. 2019. “Finding the Intersection of Neuroplasticity, Stroke Recovery, and Learning: Scope and Contributions to Stroke Rehabilitation.” Neural Plasticity 2019, no. 1: 5232374. 10.1155/2019/5232374. - DOI - PMC - PubMed

MeSH terms

LinkOut - more resources