If you aren't going to write protocols based upon the evidence you acquired, totally fucking useless. I'd have you all fired.
Short and long-term effects of robot-assisted therapy on upper limb motor function and activity of daily living in patients post-stroke: a meta-analysis of randomized controlled trials
Journal of NeuroEngineering and Rehabilitation volume 19, Article number: 76 (2022)
Abstract
Objective
To
investigate the effect of robot-assisted therapy (RAT) on upper limb
motor control and activity function in poststroke patients compared with
that of non-robotic therapy.(Investigating is useless without doing something with the information.)
Methods
We searched PubMed, EMBASE, Cochrane Library, Google Scholar and Scopus. Randomized controlled trials published from 2010 to nowadays comparing the effect of RAT and control treatment on upper limb function of poststroke patients aged 18 or older were included. Researchers extracted all relevant data from the included studies, assessed the heterogeneity with inconsistency statistics (I2 statistics), evaluated the risk of bias of individual studies and performed data analysis.
Result
Forty-six studies were included. Meta-analysis showed that the outcome of the Fugl-Meyer Upper Extremity assessment (FM-UE) (SMD = 0.20, P = 0.001) and activity function post intervention was significantly higher (SMD = 0.32, P < 0.001) in the RAT group than in the control group. Differences in outcomes of the FM-UE and activity function between the RAT group and control group were observed at the end of treatment and were not found at the follow-up. Additionally, the outcomes of the FM-UE (SMD = 0.15, P = 0.005) and activity function (SMD = 0.32, P = 0.002) were significantly different between the RAT and control groups only with a total training time of more than 15 h. Moreover, the differences in outcomes of FM-UE and activity post intervention were not significant when the arm robots were applied to patients with severe impairments (FM-UE: SMD = 0.14, P = 0.08; activity: SMD = 0.21, P = 0.06) or when patients were provided with patient-passive training (FM-UE: SMD = − 0.09, P = 0.85; activity: SMD = 0.70, P = 0.16).
Conclusion
RAT has the significant immediate benefits for motor control and activity function of hemiparetic upper limb in patients after stroke compared with controls, but there is no evidence to support its long-term additional benefits. The superiority of RAT in improving motor control and activity function is limited by the amount of training time and the patients' active participation.
Introduction
Stroke is the main cause of mortality and disability worldwide [1]. Even though the mortality rate significantly decreased from 1990 to 2019 [2], a growing number of survivors are living with motor function loss and require nursing care [1]. Impairment of upper limb function is a common problem among post-stroke patients [3]. According to the International Classification of Functioning, Disability, and Health (ICF), upper limb function can be divided into body function and structures, activity (capacity and performance), and participation [4]. The impairment of motor function could limit activity and result in difficulty in reintegrating into society for poststroke patients [5]. Several approaches for the recovery of motor function exist, but the debate about the effect of these treatments is ongoing [6]. Traditional neurological treatments, such as Bobath, proprioceptive neuromuscular facilitation (PNF) therapy, and other upper limb exercises, are well known and are common treatments for rehabilitation. However, comparing with these traditional rehabilitation treatments, robotic devices may be advantageous in terming of the output of objective measures such as speed, torque, range of motion, position, and others to evaluate and monitor the patient's improvement, and the customization of treatment sessions regarding different levels of movement impairment of patients [7]. In addition, the advantage of these manual therapies most depends on the clinical skill of therapist and hardly be reproducible, whereas RAT has high-consistency and reproducibility to allow its widespread use[8]. Moreover, there is strong evidence supporting that intensive, highly repetitive, task-oriented training promotes motor function recovery after stroke [6]. The intensity and repetition of traditional rehabilitation programs carried out by physical and occupational therapists cannot reach such a level [9]; hence, assistance from rehabilitation tools is needed. Arm robots with specialized technological machines can effectively provide high-intensity, highly repetitive, functional, and precise exercises to better improve motor control function, strength, and accuracy of movement compared with traditional manual neurological treatments [9].
Although a better therapeutic effect of robot-assisted therapy (RAT) on motor and activity function has been reported [7,10,11,12,13], disparate effects and heterogeneities between trials were found depending on the phase of poststroke [14], the amount of training [15], the control system of the robots (e.g., patient-passive control robots versus patient-active control robots) [16] and the targeted joints of robots (e.g., proximal upper limb versus distal approach) [17], several meta-analyses have discussed the influence of stage of stroke [18,19,20,21,22] and the targeted joints of robots [20,22,23] on benefits of RAT on motor control and activity function, but few study focused on the level of impairment of patients, and the parameters of RAT such as amount of training time and the control system of the robots, thus we performed comprehensive analysis to discuss those factors to try to determine the optimal treatment parameters.
It is known that the control systems of arm robots can influence the therapeutic effect [16], the arm robots can be divided into patient-passive control robots and patient-active control robots according to the control strategies of robots. Patient-passive control robots mainly deliver automated practical movements to patients, and patient-active control robots can monitor and evaluate the physical parameters and performance of voluntary motion of patients [24] and then provide assistance as needed to complete the movement initiated by patients [25]. In the latter strategy, patients pay more attention to and put more effort into the training and more actively participate in the practice [26], which is essential for improving cortical activity, excitability and motor performance [[[[[27]]]]]. Active participation is influenced by the level of impairment, the mechanical properties of the robot, the control strategies, the training mode of the robot, the instructions of the therapist and various other factors, therefore, we conducted a subgroup analysis to investigate the effect of training mode and impairment level on the superiority of RAT.
Moreover, most clinical trials have focused on the outcomes post intervention, and few studies discussed the long-term effect of RAT on activity function at follow-up. However, the changes in motor and activity function were different at the end of treatment and at follow-up [28,29], and a previous study [30] found that the gains in the Fugl-Meyer Upper Extremity (FM-UE) and Functional Independence Measure (FIM) between the robotic group and the control group were significantly different at discharge but not at the six-month follow-up.
Therefore, we performed this systematic review to investigate the effect of RAT on motor control and activity and to further discuss whether the effect of RAT persists longer than the three-month follow-up and how the amount of training, level of impairment and training mode influence the effect, this research might provide evidence for therapist to determine the optimal parameter such as total training time and training mode for clinical application of RAT.
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