Robot‐assisted therapy for upper‐limb rehabilitation in subacute stroke patients: A systematic review and meta‐analysis

Abstract

Background Stroke survivors often experience upper‐limb motor deficits and achieve limited motor recovery within six months after the onset of stroke. We aimed to systematically review the effects of robot‐assisted therapy (RT) in comparison to usual care on the functional and health outcomes of subacute stroke survivors. Methods Randomized controlled trials (RCTs) published between January 1, 2000 and December 31, 2019 were identified from six electronic databases. Pooled estimates of standardized mean differences for five outcomes, including motor control (primary outcome), functional independence, upper extremity performance, muscle tone, and quality of life were derived by random effects meta‐analyses. Assessments of risk of bias in the included RCTs and the quality of evidence for every individual outcomes were conducted following the guidelines of the Cochrane Collaboration. Results Eleven RCTs involving 493 participants were included for review. At post‐treatment, the effects of RT when compared to usual care on motor control, functional independence, upper extremity performance, muscle tone, and quality of life were nonsignificant (all p s ranged .16 to .86). The quality of this evidence was generally rated as low‐to‐moderate. Less than three RCTs assessed the treatment effects beyond post‐treatment and the results remained nonsignificant. Conclusion Robot‐assisted therapy produced benefits similar, but not significantly superior, to those from usual care for improving functioning and disability in patients diagnosed with stroke within six months. Apart from using head‐to‐head comparison to determine the effects of RT in subacute stroke survivors, future studies may explore the possibility of conducting noninferiority or equivalence trials, given that the less labor‐intensive RT may offer important advantages over currently available standard care, in terms of improved convenience, better adherence, and lower manpower cost.

Evidence of neuroplasticity with robotic hand exoskeleton for post-stroke rehabilitation: a randomized controlled trial

“…Although rehabilitation with neuro-rehabilitation robots has shown encouraging clinical results [ 5 – 18 ], it is currently limited to a very few hospitals and not widely used because of the associated high-cost and an infrastructural-requirement to station these large and complex devices with a high set-up time and limited usability [ 19 – 21 ]. Rehabilitation strategies need to take into account the multifaceted nature of the disability, which is self-changing (progressing or improving), i.e.…”

Discussion on the Rehabilitation of Stroke Hemiplegia Based on Interdisciplinary Combination of Medicine and Engineering

“…Another reports that chronic stroke hemiplegia patients receiving three months of robotic training had improvements in proprioceptive control, reactive balance, and posture control [ 22 ]. However, a systematic review and meta-analysis found that although RT has the benefit of low labor cost, when the same amount of RT is employed as conventional treatment, RT alone is not better than conventional treatment [ 23 ]. Is there a bias in efficiency studies because of one type of robot?…”

In-Bed Sensorimotor Rehabilitation in Early and Late Subacute Stroke Using a Wearable Elbow Robot: A Pilot Study

“…Robotic therapy adjunct to standard-intensity conventional therapy was more beneficial than standard intensity conventional therapy alone (Bertani et al, 2017;Veerbeek et al, 2017;Ferreira et al, 2018;Mehrholz et al, 2018). However, the meta-analysis also suggested that under similar training intensity, the improvement of upper limb function was comparable between robotic therapy and conventional therapy for stroke survivors (Veerbeek et al, 2017;Ferreira et al, 2018;Chien et al, 2020). It should be noted that those meta-analysis results derived in the aggregate of the general stroke population may not provide the best evidence of practice for stroke survivors with different levels of impairments (Winstein et al, 2016).…”

“…Despite increasing literature were presented, the effectiveness of robotics for rehabilitation in upper limb motor poststroke rehabilitation remains inconclusive (Bertani et al, 2017 ; Veerbeek et al, 2017 ; Ferreira et al, 2018 ; Mehrholz et al, 2018 ; Chien et al, 2020 ). Robotic therapy adjunct to standard-intensity conventional therapy was more beneficial than standard intensity conventional therapy alone (Bertani et al, 2017 ; Veerbeek et al, 2017 ; Ferreira et al, 2018 ; Mehrholz et al, 2018 ).…”