THIS is what is so bad about stroke. There is no database of stroke protocols and research. As a result we waste tremendous amounts of time and money that could be better spent actually providing solutions for survivors.
Systematic review of guidelines to identify recommendations for upper limb robotic rehabilitation after stroke
Giovanni MORONE 1 ✉, Angela PALOMBA 2, Alex MARTINO CINNERA 1, Michela AGOSTINI 3, Irene APRILE 4, Chiara ARIENTI 5, Matteo PACI 6, Emanuela CASANOVA 7, Dario MARINO 8, Giuseppe LA ROSA 9, Federica BRESSI 10, Silvia STERZI 10, Marialuisa GANDOLFI 11, Daniele GIANSANTI 12, Luca PERRERO 13, Alberto BATTISTINI 14, Sandra MICCINILLI 10, Serena FILONI 15, Monica SICARI 16, Salvatore PETROZZINO 16, Claudio M. SOLARO 17, Stefano GARGANO 18, Paolo BENANTI 19, Paolo BOLDRINI 20, Donatella BONAIUTI 21, Enrico CASTELLI 22, Francesco DRAICCHIO 23, Vincenzo FALABELLA 24, Silvia GALERI 5, Francesca GIMIGLIANO 25, Mauro GRIGIONI 12, Stefano MAZZOLENI 26, Stefano MAZZON 27, Franco MOLTENI 28, Maurizio PETRARCA 29, Alessandro PICELLI 11, Federico POSTERARO 30, Michele SENATORE 31, Giuseppe TURCHETTI 32, Sofia STRAUDI 33, on behalf of “CICERONE” Italian Consensus Conference on Robotic in Neurorehabilitation 
1 IRCCS Santa Lucia Foundation, Rome, Italy; 2 Multidisciplinary Department of Medicine for Surgery and Orthodontics, Luigi Vanvitelli University of Campania, Naples, Italy; 3 IRCCS San Camillo, Venice, Italy; 4 IRCCS Don Carlo Gnocchi Foundation, Florence, Italy; 5 IRCCS Don Carlo Gnocchi Foundation, Milan, Italy; 6 AUSL District of Central Tuscany, Florence, Italy; 7 IRCCS Istituto delle Scienze Neurologiche di Bologna, Unit of Rehabilitation and Neurorehabilitation Medicine, Bologna, Italy; 8 IRCCS Neurolysis Center Bonino Pulejo, Messina, Italy; 9 Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy; 10 Biomedical Campus University Foundation, Rome, Italy; 11 Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; 12 National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy; 13 Unit of Neurorehabilitation, SS. Antonio e Biagio e Cesare Arrigo University Hospital, Alessandria, Italy; 14 Azienda USL di Bologna, Bologna, Italy; 15 Padre Pio Foundation and Rehabilitation Centers, San Giovanni Rotondo, Foggia, Italy; 16 Città della Salute e della Scienza, Turin, Italy; 17 CRRF Mons. Luigi Novarese, Moncrivello, Vercelli, Italy; 18 Fondazione Don Carlo Gnocchi, Florence, Italy; 19 Pontifical Gregorian University, Rome, Italy; 20 Società Italiana di Medicina Fisica e Riabilitativa (SIMFER), Secretary General, European Society of Physical and Rehabilitation Medicine (ESPRM), Rome, Italy; 21 Piero Redaelli Geriatric Institute, Milan, Italy; 22 Pediatric Neurorehabilitation, Bambino Gesù Children’s Hospital, Rome, Italy; 23 Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, Rome, Italy; 24 Italian Federation of Persons with Spinal Cord Injuries (Faip Onlus), Rome, Italy; 25 Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy; 26 Department of Excellence in Robotics & AI, The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; 27 AULSS6 Euganea Padova - Distretto 4, Padua, Italy; 28 Villa Beretta, Costa Masnaga, Lecco, Italy; 29 The Movement Analysis and Robotics Laboratory, Bambino Gesù Children’s Hospital, Rome, Italy; 30 Department of Rehabilitation, ASL 12, Viareggio, Lucca, Italy; 31 AITO (Associazione Italiana Terapisti Occupazionali), Rome, Italy; 32 Management Institute, Sant'Anna School of Advanced Studies, Pisa, Italy; 33 Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
INTRODUCTION:
Upper limb motor impairment is one of the most
frequent stroke consequences. Robot therapy may represent a valid option
for upper limb stroke rehabilitation, but there are still gaps between
research evidences and their use in clinical practice. The aim of this
study was to determine the quality, scope, and consistency of guidelines
clinical practice recommendations for upper limb robotic rehabilitation
in stroke populations.
EVIDENCE ACQUISITION:
We searched for
guideline recommendations on stroke published between January 1st, 2010
and January 1st, 2020. Only the most recent guidelines for writing group
were selected. Electronic databases (n=4), guideline repertories and
professional rehabilitation networks (n=12) were searched. We
systematically reviewed and assessed guidelines containing
recommendation statements about upper limb robotic rehabilitation for
adults with stroke. PROSPERO registration number: CRD42020173386.
EVIDENCE
SYNTHESIS:
Four independent reviewers used the Appraisal of Guidelines
for Research and Evaluation (AGREE) II instrument, and textual syntheses
were used to appraise and compare recommendations. From 1324 papers
screened, eight eligible guidelines were identified from six different
regions/countries. Half of the included guidelines focused on stroke
management, the other half on stroke rehabilitation. Rehabilitation
assisted by robotic devices is generally recommended to improve upper
limb motor function and strength. The exact characteristics of patients
who could benefit from this treatment as well as the correct timing to
use it are not known.
CONCLUSIONS:
This systematic review has identified many opportunities to modernize and otherwise improve stroke patients’ upper limb robotic therapy. Rehabilitation assisted by robot or electromechanical devices for stroke needs to be improved in clinical practice guidelines in particular in terms of applicability.
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