New technologies promoting active upper limb rehabilitation after stroke: an overview and network meta-analysis

Abstract

INTRODUCTION The primary aim of this work was to summarize and compare the effects of active rehabilitation assisted by new technologies (virtual reality [VR], robot-assisted therapy [RAT] and telerehabilitation [TR)) on upper limb motor function and everyday living activity during the subacute and chronic phases of stroke. The secondary aims were to compare the effects of these technologies according to the intervention design (in addition to or in substitution of conventional therapy), the duration of active rehabilitation and the severity of patients’ motor impairments. EVIDENCE ACQUISITION Several databases, namely PubMed, Scopus, Embase and Cochrane Library, were searched. Studies were included if they were meta-analyses with a moderate to high level of confidence (assessed with AMSTAR-2) that compared the effects of a new technology promoting active rehabilitation to that of a conventional therapy program among patients with stroke. Network meta-analyses were conducted to compare the effects of the new technologies. EVIDENCE SYNTHESIS Eighteen different meta-analyses were selected and fifteen included in the quantitative analysis. In total these 15 meta-analyses were based on 189 different randomized controlled trials. VR (SMD≥0.25; P<0.05), RAT (SMD≥0.29; P≤0.29) and TR (SMD≥-0.08; P≤0.64) were found to be at least as effective as conventional therapy. During the subacute phase, RAT’s greatest effect was observed for patients with severe-moderate impairments whereas VR and TR’s greatest effects were observed for patients with mild impairments. During the chronic phase, the highest effects were observed for patients with mild impairments, for all studies technologies. Network meta-analyses showed that VR and RAT were both significantly superior to TR in improving motor function during the chronic phase but revealed no significant difference between VR, RAT and TR effectiveness on both motor function (during the subacute phase) and activity (during both chronic and subacute phase). CONCLUSIONS This overview provides low-to-moderate evidence that rehabilitation assisted with technologies are at least as effective as conventional therapy for patients with stroke. While VR and RAT seem to be more efficient during the subacute phase, all technologies seem to be as efficient as one another in the chronic phase.

A Smart Glove Digital System Promotes Restoration of Upper Limb Motor Function and Enhances Cortical Hemodynamic Changes in Subacute Stroke Patients with Mild to Moderate Weakness: A Randomized Controlled Trial

“…A recent review article introduced several studies using VR for upper limb rehabilitation in stroke patients, since it is a promising tool for encouraging active engagement of participants to lead to good outcomes [41]. However, one study showed only low to moderate results of VR techniques in subacute stroke patients [42]. Our results indicate not only positive effects of the RAPAEL ® Smart Glove digital system on upper limb function, but also possible evidence for underlying cortical hemodynamic changes detected by fNIRS.…”

“…In a previous study, robot-assisted therapy showed a comparable effect to conventional therapy, while VR showed no superiority to conventional therapy when provided alone [42]. However, both new techniques showed significantly better functional improvement when they were added to conventional therapy [18,42,43]. The RAPAEL ® Smart Glove digital system collects haptic data from a human body and provides real-time ROM information.…”

Face-to-face assessment versus tele-assessment of chronic stroke patients: do the results meet the needs?

“…In another recent study, researchers aimed to summarize and compare the effects of active rehabilitation assisted by new technologies (virtual reality, robot-assisted therapy and tele-rehabilitation) on upper limb function during the subacute and chronic phases of stroke (30). 15 meta-analyses were based on 189 randomized controlled trials, were included in the quantitative analysis.…”

Clinical Features to Predict the Use of a sEMG Wearable Device (REMO®) for Hand Motor Training of Stroke Patients: A Cross-Sectional Cohort Study

“…In the neurorehabilitation approach, technology-based rehabilitation (TBR) merged as a clinical modality that provides new opportunities to enhance motor recovery after stroke [ 22 , 23 ]. Indeed, the last literature overviews confirm that the use of technological solutions, such as virtual reality or robotic devices, have shown encouraging results regarding motor recovery in stroke survivors.…”

“…Indeed, the last literature overviews confirm that the use of technological solutions, such as virtual reality or robotic devices, have shown encouraging results regarding motor recovery in stroke survivors. However, there is a lack of evidence to support which approach is better [ 22 , 23 , 24 , 25 ].…”