Assessing Effectiveness and Costs in Robot-Mediated Lower Limbs Rehabilitation: A Meta-Analysis and State of the Art

Abstract

Robots were introduced in rehabilitation in the 90s to meet different needs, that is, reducing the physical effort of therapists. This work consists of a meta-analysis of robot-mediated lower limbs rehabilitation for stroke-affected patients; it aims at evaluating the effectiveness of the robotic approach through the use of wearable robots or operational machines with respect to the conventional approach (i.e., manual rehabilitation therapy). The primary assessed outcome is the patient's ability to recover walking independence, whereas the secondary outcome is the average walking speed. The therapy acceptability and the treatment costs are also assessed. The assessment shows that the robot-mediated therapy is more effective than the conventional one in reaching the primary outcome. As for the secondary outcome, there is no significant difference between the robotic (wearable robots or operational machines) and the conventional approach. Rehabilitation using wearable robots has a greater acceptability than the conventional one. This does not apply to operational machines. The cost of robotic treatment with wearable robots ranges from double to triple the cost of the conventional approach. On the contrary, rehabilitation using operational machines costs the same as the conventional treatment. Robotic rehabilitation based on operational machines is the most cost-effective approach.

Figure 1

Overall OR (and 95% CI) for independence in walk in the three different cases based on the type of robot used for the rehabilitation of patients in group A.

Figure 2

Overall MD (and 95% CI) for walking speed in the three different cases based on the type of robot used for the rehabilitation of patients in group A.

Figure 3

Overall OR (and 95% CI) for dropouts in the three different cases based on the type of robot used for the rehabilitation of patients in group A.

Figure 4

Overall OR (and 95% CI) for walking independence based on the type of robot and the condition of patients (chronic versus subacute phase).

Figure 5

Overall MD (and 95% CI) for walking speed based on the type of robot and the condition of patients (chronic versus subacute phase).

Figure 6

ICER values related to the independence in walk in the different cases based on the type of robot used and on the hours of potential use of the robot.

Figure 7

ICER values related to the independence in walking in the different cases based on the type of robot used and on the hours of potential use of the robot. Divergent ICER, for graphic purposes, set equal to € 100,000.00.