So rather than focus on getting survivors recovered, the focus was on cost. Solve the recovery problem first and then we can discuss cost. Survivors want solutions. GET THERE!
The economic cost of robotic rehabilitation for adult stroke patients: a systematic review protocol
JBI Database of Systematic Reviews and Implementation Reports:
August 2018 - Volume 16 - Issue 8 -
p 1593–1598
doi: 10.11124/JBISRIR-2017-003635
Systematic Review Protocols
Review question/objective: The objective of this review is to identify the best available evidence on the economic cost of robotic rehabilitation for adult stroke patients to improve(Not cure?) their motor movement abilities. More specifically, the objective is to identify the evidence on the economic cost of robotic training compared to conventional physiotherapy for adult stroke patients, from the perspective of hospitals.
Introduction
Stroke is a leading cause of disability with 15 million people suffering a stroke yearly.1 In the United States, the annual healthcare spending for stroke patients is USD80 billion.2 Given the large social and economic burden of stroke, it is important to identify appropriate treatment methods that can not only reduce the disability of stroke survivors, but also do so cost effectively. Traditionally, stroke patients would undergo rehabilitation post stroke and, depending on the nature of the disability, rehabilitation
would be administered by a multi-disciplinary team of physiotherapists,
occupational therapists, speech therapists and neuropsychologists, who
work together to offer integrated, holistic rehabilitation therapy.3 For physical impairments, stroke
patients will usually undergo conventional physiotherapy, which
involves patients undergoing repetitive, high intensity, task-specific
exercises that enable them to regain their motor and functional
abilities.4,5 In animal studies, it has been shown that test subjects regain motor abilities after intensive and repetitive task training.6
This was associated with a reorganization of the undamaged motor cortex
to enable recovery of motor abilities of the affected limbs.7
This “neuroplasticity” is the underlying principle of motor learning
involving repetitive, high intensity, task-specific exercises.8 However, conventional physiotherapy trainings are labor intensive and places physical strain on physiotherapists.9
To facilitate the high repetitions required, robotic
devices have been used to assist therapists to rehabilitate patients
based on high repetitions of task specific exercises.10
These robotic devices provide intensive, consistent and repetitive
cycles over long periods to train the impaired limbs of patients. There
are two main types of robotic devices: exoskeletons or end-effectors.
Exoskeletons are devices that wrap around limbs and are able to assist
each limb joint to move. End-effectors are devices that assist only the
extremities of a limb (either hands or feet).9
Regardless of the design mechanism, one key feature of robotic devices
is the ability to automatically assist patients to move their limbs when
they are unable to do so by themselves. This automated assistive
feature enables high repetitions to be achieved.
Systematic reviews conducted on these robotic devices
showed varying degrees of effectiveness. One systematic review that
assessed lower limb outcomes found that robotic-assisted gait training
increased the odds of participants being able to walk independently.11 For the sub-group of severely impaired patients, findings indicated that robotic treatment was more effective.11 In terms of upper limb outcomes, systematic reviews have found that robot-assisted arm training improved arm motor movement12,13 and activities of daily living scores.12
A recent systematic review found that robotic training was just as
effective as conventional physiotherapy for upper limb motor movement,
lower limb walking and activities of daily living, but for severely
impaired lower limb patients, robotic training was found to be more
effective than conventional training.14
Overall, these reviews showed that robotic devices, at a minimum,
offered equivalent treatment outcomes as conventional physiotherapy.
While robotic devices enable a high intensity
training regime that can be just as effective as conventional therapy,
the robotic training equipment can cost up to several hundred thousand
dollars15
per device, which is a significant capital outlay for hospitals. Hence,
the decision to introduce robotic devices into clinical settings and
offer robotic stroke rehabilitation
to patients has an important cost consideration for healthcare
providers. Despite its cost, robotic devices may increase the work
efficiency of therapists, hence more patients can be treated and this
could lead to an overall reduction in cost of treatment per patient.16 There have been clinical studies to determine the economic cost of robotic devices in the rehabilitation of stroke patients.17 However, these studies presented a mixed picture of the cost impact of robotic devices. One study18 that compared the cost-effectiveness of robotic rehabilitation with conventional rehabilitation had an uncertain finding, while another study19 found that robotic devices were economically sustainable. A third study20
compared the treatment costs and found that robotic training was less
expensive than conventional training. A preliminary search of PubMed,
Embase, JBI Database of Systematic Reviews and Implementation Reports,
Cochrane Library and PROSPERO was carried out to identify systematic
reviews that had been conducted on this topic area and no reviews were
found.
The current literature does not provide a clear determination of the cost impact of using robotic devices for stroke rehabilitation and it is the aim of this review to provide clarity to the discussion and assist healthcare providers to understand the economic cost of robotic rehabilitation.
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