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Meta-Analysis
. 2015 Nov 7;2015(11):CD006876.
doi: 10.1002/14651858.CD006876.pub4.

Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke

Jan Mehrholz  1 , Marcus Pohl, Thomas Platz, Joachim Kugler, Bernhard Elsner
Affiliations
Meta-Analysis

Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke

Jan Mehrholz et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Electromechanical and robot-assisted arm training devices are used in rehabilitation, and may help to improve arm function after stroke.

Objectives: To assess the effectiveness of electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength in people after stroke. We also assessed the acceptability and safety of the therapy.

Search methods: We searched the Cochrane Stroke Group's Trials Register (last searched February 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2015, Issue 3), MEDLINE (1950 to March 2015), EMBASE (1980 to March 2015), CINAHL (1982 to March 2015), AMED (1985 to March 2015), SPORTDiscus (1949 to March 2015), PEDro (searched April 2015), Compendex (1972 to March 2015), and Inspec (1969 to March 2015). We also handsearched relevant conference proceedings, searched trials and research registers, checked reference lists, and contacted trialists, experts, and researchers in our field, as well as manufacturers of commercial devices.

Selection criteria: Randomised controlled trials comparing electromechanical and robot-assisted arm training for recovery of arm function with other rehabilitation or placebo interventions, or no treatment, for people after stroke.

Data collection and analysis: Two review authors independently selected trials for inclusion, assessed trial quality and risk of bias, and extracted data. We contacted trialists for additional information. We analysed the results as standardised mean differences (SMDs) for continuous variables and risk differences (RDs) for dichotomous variables.

Main results: We included 34 trials (involving 1160 participants) in this update of our review. Electromechanical and robot-assisted arm training improved activities of daily living scores (SMD 0.37, 95% confidence interval (CI) 0.11 to 0.64, P = 0.005, I² = 62%), arm function (SMD 0.35, 95% CI 0.18 to 0.51, P < 0.0001, I² = 36%), and arm muscle strength (SMD 0.36, 95% CI 0.01 to 0.70, P = 0.04, I² = 72%), but the quality of the evidence was low to very low. Electromechanical and robot-assisted arm training did not increase the risk of participant drop-out (RD 0.00, 95% CI -0.02 to 0.03, P = 0.84, I² = 0%) with moderate-quality evidence, and adverse events were rare.

Authors' conclusions: People who receive electromechanical and robot-assisted arm and hand training after stroke might improve their activities of daily living, arm and hand function, and arm and hand muscle strength. However, the results must be interpreted with caution because the quality of the evidence was low to very low, and there were variations between the trials in the intensity, duration, and amount of training; type of treatment; and participant characteristics.

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Conflict of interest statement

Jan Mehrholz: was a co‐author of one included trial (Hesse 2005). He did not participant in the quality assessment or data extraction of this study. Marcus Pohl: was a co‐author of one included trial (Hesse 2005). He did not participant in the quality assessment or data extraction of this study. Thomas Platz: none known. Joachim Kugler: none known. Bernhard Elsner: none known.

Figures

Figure 1
Figure 1
Study flow diagram. Please note that several studies have been published in multiple full‐text articles. Hence the number of assessed full‐text articles and the number of identified studies may differ.
Figure 2
Figure 2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figure 3
Figure 3
Funnel plot of comparison: 1 Electromechanical and robotic assisted training versus all other intervention, outcome: 1.1 Activities of daily living at the end of intervention phase.
Figure 4
Figure 4
Funnel plot of comparison: 1 Electromechanical and robotic assisted training versus all other intervention, outcome: 1.3 Arm function at the end of intervention phase.
Figure 5
Figure 5
Funnel plot of comparison: 1 Electromechanical and robotic assisted training versus all other intervention, outcome: 1.4 Arm muscle strength at the end of intervention phase.
Analysis 1.1
Analysis 1.1
Comparison 1 Electromechanical and robotic assisted training versus all other intervention, Outcome 1 Activities of daily living at the end of intervention phase.
Analysis 1.2
Analysis 1.2
Comparison 1 Electromechanical and robotic assisted training versus all other intervention, Outcome 2 Activities of daily living at the end of intervention phase: subgroup analysis comparing acute and chronic phase.
Analysis 1.3
Analysis 1.3
Comparison 1 Electromechanical and robotic assisted training versus all other intervention, Outcome 3 Arm function at the end of intervention phase.
Analysis 1.4
Analysis 1.4
Comparison 1 Electromechanical and robotic assisted training versus all other intervention, Outcome 4 Arm muscle strength at the end of intervention phase.
Analysis 1.5
Analysis 1.5
Comparison 1 Electromechanical and robotic assisted training versus all other intervention, Outcome 5 Acceptability: drop‐outs during intervention period.
Analysis 2.1
Analysis 2.1
Comparison 2 Sensitivity analysis: by trial methodology, Outcome 1 Activities of daily living.
Analysis 2.2
Analysis 2.2
Comparison 2 Sensitivity analysis: by trial methodology, Outcome 2 Arm function.
Analysis 3.1
Analysis 3.1
Comparison 3 Subgroup analysis by treatment approach, Outcome 1 Activities of daily living at the end of intervention phase: subgroup analysis comparing different device groups.
Analysis 3.2
Analysis 3.2
Comparison 3 Subgroup analysis by treatment approach, Outcome 2 Arm function at the end of intervention phase: subgroup analysis comparing different device groups.
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Update of

References

References to studies included in this review

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References to studies excluded from this review

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References to studies awaiting assessment

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    1. Faran S, Kaick S, Eickhoff C, Mahoney R, Mauritz KH. An active and repetitive robot assisted training improves functional motor recovery of the arm in sub‐acute stroke patients. Stroke 2008;39(2):617.
    1. NCT00435617. Study of hand therapy 3 to 24 months after stroke. Clinical assessment of a massed practice therapy device ‐ study of hand therapy 3 to 24 months after stroke. http://clinicaltrials.gov/ct2/show/NCT00435617 (accessed 27 May 2015).
    1. Reinkensmeyer DJ, Wolbrecht ET, Chan V, Chou C, Cramer SC, Bobrow JE. Comparison of three‐dimensional, assist‐as‐needed robotic arm/hand movement training provided with Pneu‐WREX to conventional tabletop therapy after chronic stroke. American Journal of Physical Medicine and Rehabilitation 2012;91(11 Suppl):s232‐41. - PMC - PubMed

References to ongoing studies

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Additional references

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    1. Coote S, Stokes EK. A Gentle Robot – attitudes to the first European prototype of a robot mediated therapy system. Proceedings of the World Congress of Physical Therapy; 2003 June 7‐12 Barcelona, Spain. Barcelona, Spain: WCPT, 2003:RR‐PL‐1940.

References to other published versions of this review

    1. Mehrholz J, Platz T, Kugler J, Pohl M. Electromechanical and robot‐assisted arm training for improving arm function and activities of daily living after stroke. Cochrane Database of Systematic Reviews 2008, Issue 4. [DOI: 10.1002/14651858.CD006876.pub2] - DOI - PubMed
    1. Mehrholz J, Hädrich A, Platz T, Kugler J, Pohl M. Electromechanical and robot‐assisted arm training for improving generic activities of daily living, arm function, and arm muscle strength after stroke. Cochrane Database of Systematic Reviews 2012, Issue 6. [DOI: 10.1002/14651858.CD006876.pub3] - DOI - PubMed

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