Comparison of the Modified Barthel Index (MBI) Score Trends Among Workers With Stroke Receiving Robotic and Conventional Rehabilitation Therapy

Abstract

Introduction: Stroke is one of the top causes of adult-acquired disabilities and the fifth most prominent cause of death worldwide. Working-age populations contribute about 40% of the stroke cases which occur annually in Malaysia. The modified Barthel Index (MBI) score has been used for self-care assessment to determine if stroke patients can meet their fundamental needs. The study was designed to compare the trend of MBI scores of workers who had a stroke and underwent robotic rehabilitation therapy to those who had conventional therapy.Methodology: A cohort study was conducted among workers who had a stroke in northeastern Malaysia. They were assigned either to undergo robotic or conventional rehabilitation therapy. The robotic therapy is performed three times per day for four weeks. Meanwhile, conventional therapy involved walking exercises five days per week for two weeks. Data were collected for both therapies on the admission, at week 2 and week 4. The MBI, modified Rankin Scale (mRS) and Hospital Anxiety and Depression Scale (HADS) trends were examined one month after the therapies. The R (version 4.2.1) (R Core Team, Vienna, Austria) and RStudio (R Studio PBC, Boston, USA) were applied to perform the descriptive analyses on the respective platforms. Repeated measures of analysis of variance were performed to evaluate the outcomes trend and the effectiveness of the two therapies was also compared.Results: A total of 54 stroke patients participated in this study of which 30 (55.6%) of them received robotic therapy. The age of the subjects ranged from 24 to 59 years and the majority (74.1%) were male. Stroke outcomes were evaluated using mRS, HADS, and MBI scores. Except for their age, the individuals' characteristics did not significantly differ between those undergoing conventional therapy and those receiving robotic therapy. After four weeks, it was found that the good mRS had increased, whereas the poor mRS had decreased. Comparing the therapy groups, the MBI scores improved significantly with time, although there were no significant differences between the therapy groups. However, the interaction term between the treatment group (p=0.031) and improvements over time was significant (p=0.001), indicating that robotic was more effective than conventional therapy in improving the MBI scores. For HADS score, there was a significant difference between the therapy groups (p=0.001), with those receiving robotic therapy having higher HADS score.Conclusion: Functional recovery occurs in acute stroke patients when the mean Barthel Index score rises from the baseline (on admission) to week 2 (during therapy) and subsequently on discharge (week 4). Based on these findings, it appears that there was not one therapy superior to the other; nevertheless, robotic therapy may be better tolerated and more effective in certain individuals.

Effects of Rehabilitation Robot Training on Physical Function, Functional Recovery, and Daily Living Activities in Patients with Sub-Acute Stroke

“…There was no significant difference found in intergroup comparisons; however, owing to the significant time × group interaction effect (p < 0.05), robotic therapy was more effective in improving MBI scores than conventional therapy. The results of this study indicate that rehabilitation robot training, similar to the findings of Kamdi et al [50], is an effective intervention method for activities of daily living. In contrast to the study by Kamdi et al [50], the results of this study demonstrated significant differences in both intergroup comparisons and the time × group interaction effect, thereby proving the effectiveness of the intervention method.…”

“…The results of this study indicate that rehabilitation robot training, similar to the findings of Kamdi et al [50], is an effective intervention method for activities of daily living. In contrast to the study by Kamdi et al [50], the results of this study demonstrated significant differences in both intergroup comparisons and the time × group interaction effect, thereby proving the effectiveness of the intervention method.…”

“…Significant differences were found in both intergroup comparisons and time × group interaction effects (p < 0.05). When examining previous research on rehabilitation robot training and activities of daily living in stroke patients, Kamdi et al [50] divided 54 stroke patients into two groups: a robot therapy group receiving three sessions per day for four weeks and a conventional therapy group performing walking exercises five days a week for two weeks. They measured the MBI at admission and at two weeks and four weeks after admission.…”

Classification and Quantification of Physical Therapy Interventions across Multiple Neurological Disorders: An Italian Multicenter Network

“…Change in Modified Barthel Index (MBI): The MBI is a measure of physical disability used widely to assess behavior relating to ADL for subjects with disabling conditions. Higher scores indicate a low level of disability [34].…”