Short and long-term effects of robot-assisted therapy on upper limb motor function and activity of daily living in patients post-stroke: a meta-analysis of randomized controlled trials

Abstract

Objective To investigate the effect of robot-assisted therapy (RAT) on upper limb motor control and activity function in poststroke patients compared with that of non-robotic therapy. Methods We searched PubMed, EMBASE, Cochrane Library, Google Scholar and Scopus. Randomized controlled trials published from 2010 to nowadays comparing the effect of RAT and control treatment on upper limb function of poststroke patients aged 18 or older were included. Researchers extracted all relevant data from the included studies, assessed the heterogeneity with inconsistency statistics (I2 statistics), evaluated the risk of bias of individual studies and performed data analysis. Result Forty-six studies were included. Meta-analysis showed that the outcome of the Fugl-Meyer Upper Extremity assessment (FM-UE) (SMD = 0.20, P = 0.001) and activity function post intervention was significantly higher (SMD = 0.32, P < 0.001) in the RAT group than in the control group. Differences in outcomes of the FM-UE and activity function between the RAT group and control group were observed at the end of treatment and were not found at the follow-up. Additionally, the outcomes of the FM-UE (SMD = 0.15, P = 0.005) and activity function (SMD = 0.32, P = 0.002) were significantly different between the RAT and control groups only with a total training time of more than 15 h. Moreover, the differences in outcomes of FM-UE and activity post intervention were not significant when the arm robots were applied to patients with severe impairments (FM-UE: SMD = 0.14, P = 0.08; activity: SMD = 0.21, P = 0.06) or when patients were provided with patient-passive training (FM-UE: SMD = − 0.09, P = 0.85; activity: SMD = 0.70, P = 0.16). Conclusion RAT has the significant immediate benefits for motor control and activity function of hemiparetic upper limb in patients after stroke compared with controls, but there is no evidence to support its long-term additional benefits. The superiority of RAT in improving motor control and activity function is limited by the amount of training time and the patients' active participation.

Effects of EMG-based robot for upper extremity rehabilitation on post-stroke patients: a systematic review and meta-analysis

“…As described in previous studies ( Wang et al, 2021 ; Zhang et al, 2022 ), the amount of intervention was estimated by total time. We discovered that there was a significant difference in the upper limb motor function in both subgroups at the end of treatment between EMG-based robot therapy and conventional therapies, and the effect size was lager in subgroup with total training time ≤1000 min (SMD:0.67, 95% CI:0.25–1.09) than subset with total time >1000 min (SMD:0.58, 95% CI:0.14–1.03) ( Figure 5A ).…”

“…Voluntary motor intention is crucial in the rehabilitation of motor function after stroke ( Yang et al, 2022 ). Rehabilitation training that incorporates participants’ intention input is more effective which further facilitate active participation ( Hu et al, 2009 ; Hu et al, 2021 ; Zhang et al, 2022 ) and interactive control ( Cozens, 1999 ). The formation of a sensorimotor cycle by the voluntary intention output and the afferent sensor might facilitate motor relearning in post-stroke ( Cauraugh et al, 2000 ).…”

Effect of different modalities of artificial intelligence rehabilitation techniques on patients with upper limb dysfunction after stroke—A network meta-analysis of randomized controlled trials

“…We included 71 studies in the FMA-UE-Total in the comparison ( 51 – 66 , 69 – 80 , 87 , 88 , 91 , 92 , 147 ). As the network evidence map in this study did not form a closed loop, indirect comparisons and inconsistency tests could not be performed ( 148 ).…”

How Do Motor and Sensory Function Correlate with Daily Performance Recovery after Post-Stroke Robotic Intervention? A Secondary Analysis of a Non-Randomized Controlled Trial

“…One clinical trial concluded that although a robotic-assisted therapy improved deficits in sensorimotor functions of the upper limb, this improvement did not translate into increased performance in activities or improved quality of life [ 45 ]. In this regard, a recent systematic review and meta-analysis concluded that this type of intervention can improve not only sensorimotor function but also activity performance in the stroke population, but only if applied for a total of 15 h or more and in patients with a high level of participation [ 46 ]. The challenge of how to translate improvements in body functions to activity performance and participation is common to other intervention approaches in this population, such as nerve stimulation [ 47 ].…”