Saturday, June 15, 2024

Impact of Assistive Devices on Upper Limb Recovery in Stroke Patients: A Comprehensive Review

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The significance of selecting appropriate assistive devices in stroke rehabilitation cannot be overstated. Proper devices can greatly influence the functional recovery of a patient’s upper limbs, thereby affecting their ability to perform daily activities and functional tasks. This review delves into the clinical evidence from randomized controlled trials (RCTs) to evaluate the therapeutic effects of commonly used assistive devices on upper extremity function in stroke patients.

In stroke rehabilitation, the choice of assistive devices is critical for patients’ recovery. These devices play a crucial role in the functional recovery of the upper limb and impact the overall activities and tasks patients can perform. The selection of suitable devices is essential for achieving optimal rehabilitation outcomes.

Research Objectives and Methods

The primary aim of this review was to comprehensively analyze and summarize the clinical evidence from RCTs regarding the therapeutic effects of commonly used assistive devices on upper extremity function in stroke patients. The review included qualitative synthesis of therapeutic interventions, intensity, outcomes, and a summary of results. Additionally, the study examined risk of bias, heterogeneity, mean difference, 95% confidence interval, and I-squared value. Tools such as RoB 2 and RevMan 5.4 were utilized for the analysis.

A total of 31 RCTs were included in the qualitative synthesis. The process of randomization and the reporting of results exhibited minimal bias. However, there were concerns regarding bias from intended interventions and missing outcome data. In the quantitative synthesis, 16 RCTs were analyzed, revealing significant differences in the Fugl-Meyer assessment-upper extremity functioning (FMA-UE) scores between groups.

Key Findings

The results indicated a total mean difference in FMA-UE scores of 2.40 (95% confidence interval: 0.21, 4.60) between groups. Heterogeneity values included Tau² = 0.32, chi-square = 8.22, degrees of freedom = 8 (p = 0.41), and I² = 3% for FMA-UE. The test for the overall effect produced Z = 2.14 (p = 0.03) in patients with chronic stroke. Despite this, no significant differences were found in other outcome measures.

Practical Inferences for Clinicians

– Upper-limb robots showed a significant improvement in FMA-UE scores for patients with chronic stroke, although the mean difference was lower than the minimally important difference.
– Issues with bias from intended interventions and missing outcome data need to be addressed in future studies.
– Upper-limb robots facilitate more repetitions of movements within specific time frames, potentially enhancing patient function.

The study concluded that upper-limb robots did not demonstrate significant superiority over conventional treatments for improving upper limb function, except for FMA-UE scores in chronic stroke patients. Despite the lower mean difference, these devices may still contribute to improved function by enabling more movement repetitions.

Original Article: J Hand Ther. 2024 May 24:S0894-1130(23)00202-8. doi: 10.1016/j.jht.2023.12.014. Online ahead of print.

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