Date Presented 04/04/19
Approximately 795,000 Americans experience a stroke each year, which leads to a decrease in function. Robotic therapy is being tested as an intervention for upper-extremity rehabilitation in stroke. However, research indicates that there is insufficient evidence to support the effectiveness of robotic therapy over conventional therapy. As OTs consider additional methods of delivering therapy, this review informs them about the effectiveness of robotics.
Primary Author and Speaker: Rochelle Mendonca
Additional Authors and Speakers: Kerry Sheehy, Emily Freedman, Namrata Grampurohit
PURPOSE: Approximately 795,000 Americans experience a stroke each year, which leads to a decrease in function. Robotic therapy is being tested as an intervention for upper extremity rehabilitation in stroke. However, research indicates that there is insufficient evidence to support the effectiveness of robotic therapy over conventional therapy. This study systematically reviews the evidence for effectiveness of rehabilitation robotic interventions on upper extremity (UE) function and pain for adults with chronic stroke.
DESIGN: A systematic review was conducted in 6 databases (Prospero Registration #CRD42017062254). Inclusion criteria were peer reviewed randomized trials published between 2007 and 2017, adults aged 18 and over, chronic stroke, upper extremity pain and function, and robots. The exclusion criteria were acute or subacute stroke, children, animal studies, non-randomized and non-experimental designs.
METHOD: The screening and full-text retrieval were completed independently by two reviewers in the Rayyan Systematic Review Software. Two additional reviewers were available for conflict resolution. Data extraction included title, author, date, setting, age, time post stroke, type of stroke, inclusion & exclusion criteria, number of participants, study design, robotic intervention description and dose, alternate intervention description and dose, UE function and pain outcomes, and other relevant outcomes. The methodological quality for risk of bias was assessed using PEDro and CONSORT. AJOT guidelines for systematic reviews were applied to determine strength of evidence. The PRISMA guidelines for reporting systematic reviews were followed.
RESULTS: A total of 2,139 articles were retrieved after removal of duplicates. Twenty randomized trials were included for full text review, including 10 good, 9 fair and one poor quality study. Among the good quality studies, 4 showed significant within group improvements in the robot group on UE functional assessments such as the Fugl Meyer (FM), Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), and Motor Activity Log (MAL). Seven of the good quality studies showed significant between group differences on the FM, MAL, SMFT, Stroke Impact Scale (SIS), Nottingham Extended ADL Scale (NEADL), and ABILHAND. In the fair quality studies, 7 showed significant within group differences for the robot group on the FM, SIS, ARAT, MAL, Box and Block Test, Strength and Range of Motion. Three showed significant between group differences on the FM, ARAT and strength testing. Based on these results, there was strong evidence for the effectiveness (4 good and 7 fair quality studies) of robotic intervention in a chronic stroke population in improving upper extremity functional outcomes. There was also strong evidence for the comparative effectiveness (7 good quality and 3 fair quality studies) of robotic interventions compared to alternative therapies in this population. Three of the twenty studies reported pain outcomes, however the measurement of pain was inconsistent and there were no differences obtained in pain outcomes.
CONCLUSION: Overall, this review found robotic interventions to have positive upper extremity function outcomes for individuals with chronic stroke in comparison with other alternative therapies, which informs the use of these interventions in clinical practice. Future studies need to systematically review the impact of robotic interventions on additional outcomes such as pain and ADL performance.
IMPACT: This review provides useful information about robotic interventions for chronic stroke survivors and allows clinicians to translate recent high quality evidence into clinical practice. It can also inform the design of future research studies to improve rigor.
References
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