Globally, the risk of stroke among people over 25 years of age is approximately 25% [1]. In 2019, there were 101 million survivors and 6.55 million deaths due to stroke [2]. The loss of healthy years due to early death and disability from stroke is the second highest among people over 50 years of age, which carries a significant disease burden [3]. Since the disability rate after a stroke is as high as 30%, many stroke survivors are greatly affected by their physical function and ability to perform daily activities [4,5].

Rehabilitation therapy is the main measure to recover physical function and independent living ability in stroke survivors [6]. According to the Global Burden of Disease Study 2019, more than four-fifths of stroke survivors need rehabilitation [7]. Earlier initiation of rehabilitation, such as upper-limb and gait training, is associated with better stroke rehabilitation outcomes [8]. Rehabilitation and training to improve limb dysfunction should be provided in hospitals within one month of a stroke [9]. Physical rehabilitation plays a positive role in functional recovery, especially in improving motor function and balance [10]. Stroke survivors often have reduced motor function in the arms and hands. Approximately 38% and 34% of stroke survivors suffer from severe and moderate upper-limb motor impairments, respectively [11]. Impaired arm motor function not only affects balance but also limits basic activities of daily living (ADLs) [12,13]. Upper-limb function and balance are related to ADLs such as eating, dressing, and balancing while walking. Early physical therapy is recommended to treat upper-limb motor impairments and balance disorders after a stroke [14].

Tai Chi, a physical and mental sport originating from the ancient Chinese martial arts, is the fourth most popular physical activity among middle-aged and elderly people in China [15]. Previous studies [16,17] have shown that Tai Chi improves limb motor function and balance in stroke survivors. However, a set of Tai Chi contains at least 24 or more movements with a certain exercise sequence, which increases the difficulty of learning and memory for the elderly [18,19]. The movements of Tai Chi require the exercisers to balance forward and backward, alternate weights on left and right knees, and stretch and pull back [20]. Hemiplegic stroke survivors often have balance dysfunction with Berg Balance Scale (BBS) score below 40, and are not suitable for Tai Chi such as large movement range and high-intensity exercise [[21], [22], [23]]. Tai Chi Yunshou (TCY), the fundamental form of Tai Chi, mainly consists of simple upper-limb spiral movements [20,24]. The shoulders remain relaxed, and the head, trunk, and pelvis rotate as a unit slightly around the spine during TCY exercises, making it easier for the exerciser to maintain balance [25,26]. The lower-extremity movements of TCY are simple and easy to perform, moving back and forth from side to side [26]. Compared with Tai Chi's risk of falling in class [27,28], simple TCY may be safer for stroke survivors [29].

Although the proportion of stroke survivors requiring rehabilitation is high [7], the clinical rate of rehabilitation treatment is low. The proportion of inpatient rehabilitation for acute stroke is 13.4–56.5% (median: 31.5%) in high-income countries [30]. The low rate of physical rehabilitation in patients with stroke may be due to the exercise methods, which must be guided and recommended by professional rehabilitators [31,32], and the complex exercise methods may not be completely independent [33]. TCY is easy for the elderly to learn and does not require guidance from physical therapists after mastering it [34], which is conducive to early hospital exercise rehabilitation training for stroke survivors [35]. In conclusion, TCY may be a suitable form of physiotherapy for stroke survivors to improve upper-limb function and balance.

The role of TCY in upper-limb function and balance after a stroke is unclear, and the evidence of systematic review is lacking. Therefore, we designed and conducted this systematic review and meta-analysis to evaluate the effects of TCY on upper-limb function and balance rehabilitation in stroke survivors, with a view to providing a complementary exercise therapy for stroke rehabilitation.