A systematic review of early neuroimaging and neurophysiological biomarkers for post-stroke mobility prognostication

ObjectivePrognostication may help guide mobility rehabilitation planning and goal setting post-stroke. This systematic review aimed to examine the prognostic capacity of early neuroimaging and neurophysiological biomarkers of mobility outcomes up to 24 months post-stroke.Data sourcesMEDLINE/EMBASE was searched from inception to May 2026. Cohort studies that reported neuroimaging or neurophysiological biomarkers measured <14 days post-stroke and mobility outcome(s) assessed >14 days but ≤24 months post-stroke were included.Review methodsBiomarker analyses were classified by statistical analysis approach (association, discrimination/classification, validation). Magnitude of relevant statistical measures was the primary indicator of prognostic capacity. Risk of bias was assessed using the Quality in Prognostic Studies tool.ResultsTwenty-six reports from 23 independent study samples (n = 2678 participants) were included. Biomarkers were measured a median of 9.3 days post-stroke, and outcomes were assessed between 1 and 24 months. One hundred and nine biomarker analyses were identified (84 neuroimaging, 25 neurophysiological). Most analyses were association (88%), and few were discrimination/classification (10%) and validation (2%). Structural and functional corticospinal tract integrity metrics were frequently investigated, but findings were mostly small or non-significant. Lesion location and size findings were also commonly examined, but findings were inconsistent. Common methodological limitations included small sample sizes, moderate to high risk of bias, poor magnitude reporting and heterogeneous outcomes and follow-up timepoints.ConclusionCurrent evidence is insufficient to support the use of early neuroimaging and neurophysiological biomarkers for post-stroke mobility prognostication. International collaboration using harmonised methodologies, standardised statistical reporting and consistent outcome measures and timepoints is needed to generate meaningful prognostic information to guide rehabilitation.RegistrationCRD42022350771.