Reevaluating attentional focus on motor performance according to expertise: A stratified network meta-analysis

Attentional focus is widely used to enhance motor performance, but reported effects vary, likely due to inconsistent operationalization of attentional focus and differing participant expertise. This study audited, reclassified, and compared attentional focus for motor performance using network meta-analysis. PubMed, Web of Science, and SPORTDiscus were searched to Feb 19, 2026. Eligible experimental studies in healthy participants compared at least two conditions among internal focus (IF), external focus (EF), proximal external focus (PEF), distal external focus (DEF), and holistic focus (HF). Attentional focus instructions were audited and recoded using prespecified operational definitions; expertise was classified using training and performance caliber tiers (Tier). Eighty-seven studies were included, with reclassification required in 78 studies. Before reclassification, DEF was consistently the top-ranked strategy. After reclassification, the ranking hierarchy changed. In the primary analysis, DEF and HF showed comparable benefits versus Control (CON). Secondary analyses revealed: DEF most favorable in Tiers 0-1 and Tier 2. In contrast, HF ranked highest in Tiers 3-5, where IF was explicitly detrimental and PEF yielded no significant effect. Attentional-focus classification may influence meta-analytic conclusions, and Tier may further shape these patterns. However, conclusions should remain cautious given small-study-effect sensitivity and potential reporting bias.