Systematic review of guidelines to identify recommendations for upper limb robotic rehabilitation after stroke

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

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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.