In the evolving landscape of poststroke rehabilitation, robot technology has emerged as a promising frontier. Over the last 30 years, the integration of upper limb robots (UL-RTs) into therapeutic practices has accelerated, aiming to enhance motor function recovery in stroke survivors. This study critically evaluates the efficacy of UL-RTs in comparison to non-robotic interventions and identifies variables affecting the observed effect sizes (ESs).
The research utilized randomized controlled trials (RCTs) to compare the effects of UL-RTs with other interventions on patients with upper limb limitations poststroke. Comprehensive data extraction was conducted by two independent reviewers from several databases, including PubMed and Embase, covering studies up to August 1, 2022. Meta-analyses were performed to measure outcomes such as UL-muscle synergism, muscle power, muscle tone, capacity, self-reported motor performance, and basic activities of daily living (ADLs).
Methodology
A total of 90 RCTs, encompassing 4,311 participants, were included, with a median PEDro score of 6. Meta-analyses of 86 trials involving 4,240 participants revealed small but significant improvements in UL-muscle synergism, muscle power, motor performance, and basic ADLs. However, no significant effects were detected for muscle tone or UL-capacity, except when exoskeletons were used.
Key Findings
Meta-regressions indicated a positive association between baseline FM-UL scores and effect sizes for UL-capacity, particularly in the acute and early-subacute phases poststroke. Despite the modest gains in motor impairment, these did not translate into substantial improvements in UL-capacity at a clinical level. The findings underscore the necessity for a deeper mechanistic understanding to guide the development of forthcoming UL-RTs.
Practical Inferences
– Early intervention with UL-RTs poststroke might yield better results, particularly in acute and early-subacute phases.
– Patients with higher baseline FM-UL scores tend to show more significant capacity improvements.
– Exoskeletons could be more effective in enhancing UL-capacity compared to other robotic technologies.
These insights highlight the importance of patient selection and timing in the application of UL-RTs, suggesting that personalized rehabilitation strategies could maximize therapeutic outcomes.
The study concludes that while UL-RTs offer incremental benefits in motor function, their impact on overall upper limb capacity remains limited without a more nuanced understanding of motor learning and recovery mechanisms. Future research should focus on these underlying interaction effects to enhance the efficacy of next-generation rehabilitation technologies.
Original Article: Neurology. 2024 Jul 23;103(2):e209495. doi: 10.1212/WNL.0000000000209495. Epub 2024 Jun 13.
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