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Meta-Analysis
. 2020 Aug;10(8):e01742.
doi: 10.1002/brb3.1742. Epub 2020 Jun 26.

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

Wai-Tong Chien  1 , Yuen-Yu Chong  1 , Man-Kei Tse  1 , Cheuk-Woon Chien  2 , Ho-Yu Cheng  1
Affiliations
Meta-Analysis

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

Wai-Tong Chien et al. Brain Behav. 2020 Aug.

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 ps 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.

Keywords: meta-analysis; rehabilitation; robot-assisted therapy; stroke; sub-acute.

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Conflict of interest statement

The authors declare that there are no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA flow chart of study selection
FIGURE 2
FIGURE 2
Summary of risk of bias of each included study
FIGURE 3
FIGURE 3
Summary of risk of bias across all included studies
FIGURE 4
FIGURE 4
Forest plot: Comparison of the effect of robotic‐assisted therapy and usual care on motor control at post‐treatment
FIGURE 5
FIGURE 5
Forest plot: Comparison of the effect of robotic‐assisted therapy and usual care on functional independence at post‐treatment
FIGURE 6
FIGURE 6
Forest plot: Comparison of the effect of robotic‐assisted therapy and usual care on upper extremity performance at post‐treatment
FIGURE 7
FIGURE 7
Forest plot: Comparison of the effect of robotic‐assisted therapy and usual care on muscle tone at post‐treatment
FIGURE 8
FIGURE 8
Forest plot: Comparison of the effect of robotic‐assisted therapy and usual care on quality of life at post‐treatment
See this image and copyright information in PMC

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