Motivation in motor training interventions after stroke-a systematic review

Motivation plays an important role in the rehabilitation process and can significantly influence its success. The objective of this systematic review was to identify which therapy interventions targeting motor improvement after stroke have also been evaluated in terms of their motivational effects.

A comprehensive literature search was conducted in August 2025 using the databases CINAHL, MEDLINE, Embase and PEDro. Randomised controlled trials were eligible for inclusion if they reported at least one outcome related to both motor performance and motivation. Relevant trials were identified, screened, and summarized in accordance with the PRISMA reporting guidelines. For each assessment, the direction of effect was estimated. The review was prospectively registered in PROSPERO (Trial-No. CRD42023448438).

Overall, motivation was measured only rarely. 17 trials including a total of 521 stroke survivors met the inclusion criteria. In general, all included studies showed a high risk of bias due to the inability to blind the intervention. Exergaming was the most frequently investigated intervention, others described animal-assisted therapy, smart technology and boxing. Four exergame trials and one animal-assisted trial demonstrated beneficial effects of the intervention on motivation and motor performance.

Current evidence on the impact of motor interventions after stroke on motivation is weak. Exergames seems to have promising potential to motivate stroke patients and improve motor performance; however, the underlying mechanisms remain insufficiently understood. Social interaction, effective in one animal-assisted therapy, represents another promising avenue. Overall, motivation and its standardized assessment warrant greater research attention to enhance therapeutic outcomes.