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. 2024 Sep 21;14(9):941.
doi: 10.3390/brainsci14090941.

Effectiveness of Two Models of Telerehabilitation in Improving Recovery from Subacute Upper Limb Disability after Stroke: Robotic vs. Non-Robotic

Arianna Pavan  1 , Alessio Fasano  1 , Stefania Lattanzi  1 , Laura Cortellini  1 , Valeria Cipollini  1 , Sabina Insalaco  1 , Maria Cristina Mauro  1 , Marco Germanotta  1 , Irene Giovanna Aprile  1
Affiliations

Effectiveness of Two Models of Telerehabilitation in Improving Recovery from Subacute Upper Limb Disability after Stroke: Robotic vs. Non-Robotic

Arianna Pavan et al. Brain Sci. .

Abstract

Background/objectives: Finding innovative digital solutions is fundamental to ensure prompt and continuous care for patients with chronic neurological disorders, whose demand for rehabilitation also in home-based settings is steadily increasing. The aim is to verify the safety and the effectiveness of two telerehabilitation (TR) models in improving recovery from subacute upper limb (UL) disability after stroke, with and without a robotic device.

Methods: One hundred nineteen subjects with subacute post-stroke UL disability were assessed for eligibility. Of them, 30 patients were enrolled in the study and randomly assigned to either the Robotic Group (RG), undergoing a 20-session TR program, using a robotic device, or the Non-Robotic Group (NRG), undergoing a 20-session TR program without robotics. Clinical evaluations were measured at baseline (T0) and post-intervention (T1, 5 weeks after baseline), and included assessments of quality of life, motor skills, and clinical/functional status. The primary outcome measure was the World Health Organization Disability Assessment Schedule 2.0, evaluating the change in perceived disability.

Results: Statistical analysis shows that patients of both groups improved significantly over time in all domains analyzed (mean decrease from baseline in the WHODAS 2.0 of 6.09 ± 2.62% for the NRG, and of 0.76 ± 2.21% for the RG), with a greater improvement of patients in the NRG in motor (Fugl-Meyer Assessment Upper Extremity-motor function, Box and Block Test) and cognitive skills (Trail Making Test-A).

Conclusions: This study highlights the potential of TR programs to transform stroke rehabilitation by enhancing accessibility and patient-centered care, promoting autonomy, improving adherence, and leading to better outcomes and quality of life for stroke survivors.

Keywords: home-based; rehabilitation; rehabilitation protocol; robot-assisted rehabilitation training; robotics; stroke; telehealth; upper extremity; virtual reality.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
CONSORT diagram showing the different phases of the study.
Figure 2
Figure 2
The two telerehabilitation models. (a) A patient randomized to the Non-Robotic Group performs upper limb exercises remotely connected to the therapist; (b) A patient randomized to the Robotic Group performs upper limb exercises using the end-effector remotely connected to the therapist.
Figure 3
Figure 3
Study outcome at T0 and T1. The graphs for the different scales evaluated are shown in the figures above: (a) WHODAS. A statistically significant decrease on the scale indicates a decrease in disability with the treatment (*: p < 0.05); (b) Fugl-Meyer Assessment UE—motor function. The statistically significant increase on the scale indicates an improvement in motor performance. A difference in behavior between the two groups was also observed (##: p < 0.01); (c) Fugl-Meyer Assessment UE—sensation. The statistically significant increase on the scale indicates an improvement in sensitivity (***: p < 0.001); (d) Action Research Arm Test (ARAT). The statistically significant increase on the scale indicates an improvement in motor performance (***: p < 0.001); (e) Box and Block Test. The statistically significant increase on the scale indicates an improvement in dexterity. Different behavior was also observed between the two groups (#: p < 0.05); (f) Numerical Rating Scale (NRS). A decrease on the scale indicates a decrease in pain; (g) Montreal Cognitive Assessment (MoCA). The statistically significant increase on the scale indicates improvement in cognitive function (**: p < 0.01); (h) Trail Making Test-A (TMTA). The statistically significant decrease in the test indicates improvement in visual and spatial search tasks. Differences in behavior between the two groups were also observed (#: p < 0.05); (i) Trail Making Test-B (TMTB). The statistically significant decrease in the test indicates improvement in visual and spatial search tasks (**: p < 0.01); (j) Symbol Digit Modalities Test (SDMT). An increase on the scale indicates an improvement in attention and working memory; (k) Beck Depression Inventory (BDI). A statistically significant decrease in the test indicates a reduction in depression (*: p < 0.05); (l) STAY-Y1. A decrease on the scale indicates a decrease in anxiety.
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