Oral Presentation Smart Strokes Annual Scientific Meeting 2024

Impact of device and programme features on the efficacy of upper-limb robotic rehabilitation following stroke: A systematic review and meta-analysis (106894)

Kate Charlesworth 1 , Usman Rashid 2 , Sharon Olsen 1 , Edgar Rodriguez-Ramirez 3 , Will Browne 4 , Gemma Alder 1 , Nada Signal 1
  1. Auckland University of Technology, Northcote, Auckland, New Zealand
  2. New Zealand College of Chiropractic, Mount Wellington, Auckland, New Zealand
  3. Victoria University of Wellington, Te Aro, Wellington, New Zealand
  4. Queensland University of Technology, Brisbane City, QLD, Australia

Introduction

Upper limb (UL) impairment is common following stroke and frequently limits everyday activities. Due to limited resources, current therapy levels are insufficient to optimise functional improvement. Robotic devices have potential to augment UL stroke rehabilitation, however, knowledge regarding the optimal device features and delivery methods is limited. This systematic review aimed to determine the efficacy of UL robotic rehabilitation compared with conventional rehabilitation, and to explore the features of robotic devices and rehabilitation programmes which influence outcomes.

Methods 

Six electronic databases were searched for dose-matched RCTs that compared robotic versus conventional rehabilitation following stroke, and measured activity-level changes in UL outcomes. The efficacy of robotic compared with conventional rehabilitation was evaluated using random-effects (I2 ≥50%) or fixed-effect (I2 <50%) models. Subgroup analyses exploring device and programme features utilised separate meta-analyses for constructs with categorical variables (e.g. exoskeleton vs. end-effector device type), and meta-regression for continuous variables (e.g. total training amount).

Results 

The review included 54 studies (2,744 participants). Robotic rehabilitation was significantly more effective at improving UL capacity than conventional rehabilitation (SMD 0.14, 95%CI [0.02, 0.26]), though gains were not maintained at follow-up. In contrast, there were no significant differences between robotic and conventional approaches for ADL outcomes. Several device and programme features impacted efficacy; these included assistance provided by the device (i.e. full, partial), UL joints being moved (i.e. proximal, distal), device laterality (i.e. unilateral, bilateral), and device degrees of freedom.

Conclusion 

The results suggest robotic rehabilitation can benefit UL capacity outcomes but not ADLs. However, several device features and delivery methods appear to influence efficacy outcomes, and should be considered in future research and when designing and implementing devices in stroke rehabilitation.

Relevance to clinical practice or patient experience: 

Conveying an understanding of various device features and implementation options that can be manipulated by designers and therapists.