Feasibility and Cost of Robot-assisted Upper Limb Rehabilitation with Different Levels of Supervision (RHB Clinic)

Feasibility and Cost of Robot-assisted Upper Limb Rehabilitation with Different Levels of Supervision: an Interventional Study

Upper limb impairments are often a result of neurological or traumatic injuries (e.g., stroke, traumatic brain injuries). These impairments may decrease independence in performing activities of daily living, severely affecting patients' quality of life. Growing evidence shows that increasing upper limb therapy dose for patients could improve functional outcomes and prevent their long-term deterioration. However, due to limited resources (e.g., the number of therapists) and high rehabilitation-related costs, providing a higher therapy dose to patients is challenging, both in the clinic and after discharge, and finding new models of care is therefore critical.

Minimally supervised or unsupervised robot-assisted therapy (i.e., patients training with rehabilitation devices with minimal to no supervision of an external person) holds the promise of allowing an increase in therapy dose with little impact on the additional resources needed. Because of their ability to provide active support and measure a wide set of parameters, actuated (active) rehabilitation robots seem to be the best solution for this therapy setting. However, such devices are often complex to use and have never been extensively tested minimally or unsupervised. Consequently, the data available on their feasibility and cost-effectiveness is limited.

At the Rehabilitation Engineering Laboratory (RELab, ETH Zurich), we developed ReHandyBot, an actuated device for unsupervised upper limb therapy. The device has already been tested with stroke patients in an unsupervised setting, with positive results regarding usability and increase in therapy dose. The main goal of this project is, therefore, to investigate the feasibility and cost of our robot-assisted continuum of care model (i.e., from inpatient to ambulatory). Specifically, we aim to evaluate the feasibility of integrating ReHandyBot into the clinical routine and perform a preliminary cost-benefit analysis of supervised, minimally supervised, and unsupervised robot-assisted therapy. Furthermore, we will also gather data on the overall dose of robot-assisted therapy and the intensity of use of the device in a clinical and ambulatory setting.

Study Overview

• Status: Recruiting
• Conditions: Upper Limb Sensorimotor Deficits
• Intervention / Treatment: Device: ReHandyBot

Detailed Description

The ReHandyBot is a platform for hand rehabilitation with two degrees of freedom, namely forearm pronation/supination and finger flexion/extension. This device allows performing exercises targeting somatosensation and motor functions. Different exercises are implemented using virtual reality and haptic feedback; the interaction forces between subjects and ReHandyBot are measured by force sensors in the handles, allowing the control of a virtual hand and the physical interaction with the virtual environment. Mechanical properties (e.g., size, stiffness) of the objects displayed in the virtual environment are rendered by the motion/force of the instrumented handles. The type and difficulty level of the exercises are patient-specific and are automatically adapted throughout the therapy.

The duration and frequency of the therapy sessions with ReHandyBot depend on the specific patient's needs and are set according to the therapist's instructions.

The main goals of this study are to:

(i) Evaluate the feasibility of integrating ReHandyBot into the routine of rehabilitation clinics and ambulatories.

(ii) Perform a cost-benefit analysis of supervised, minimally supervised, and unsupervised therapy with the device.

The secondary goals are to investigate:

(iii) The intensity of use of ReHandyBot by the facilities. (iv) The increase in therapy dose for the patients using the device minimally or unsupervised compared to usual care.

(v) The quantity and characteristics of patients who can train supervised, minimally, or unsupervised with the device.

(vi) Usability and user experience.

All the patients admitted to the clinic or ambulatory will be screened for participation in this study. Eligible patients will receive robot-assisted therapy sessions with the ReHandyBot in parallel to their conventional therapy program. During therapy with ReHandyBot, the patient sits comfortably on a chair in front of a screen and places the fingers of the impaired hand on the handles of the device.

The eligibility of the patients will be checked during the admission visit, after which, for eligible patients, a trial session with ReHandyBot will be scheduled. During the trial session, the supervising therapist will decide if the patient can really benefit from training with ReHandyBot, and if yes, the therapist will integrate supervised therapy sessions with the device into the therapy schedule of the patient. Then, during the supervised sessions, the therapist will use a checklist to decide if a patient can train minimally supervised (i.e., group sessions) or unsupervised. If this will be the case, the minimally or unsupervised therapy sessions will be added to the therapy schedule of the patient. The therapy sessions with ReHandyBot (e.g., frequency, duration) will be scheduled based on the therapist's instruction and may vary between patients, depending on their specific needs. On the day of the last session with ReHandyBot, patients will fill in questionnaires to rate its usability and user experience.

For each recruited patient, data regarding demographics, medical condition, clinical and cognitive assessments, therapy dose, and device data will be recorded on the CRF. Medical and assessment data will be data routinely collected at the clinic and ambulatory. We will not perform evaluations specifically for this study.

At the end of the study, data regarding costs, intensity of use, and device retention will be recorded.

• Study Type: Interventional
• Enrollment (Estimated): 100
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Giada Devittori, Dr.; Phone Number: 0041445107234; Email: giada.devittori@hest.ethz.ch

Study Locations

• Switzerland
  • Brissago, Switzerland, 6614
    • Recruiting
    • Clinica Hildebrand Centro di riabilitazione Brissago
    • Contact: Daria Dinacci, Dr. med.; Phone Number: 0041917868633; Email: d.dinacci@clinica-hildebrand.ch
  • Lugano, Switzerland
    • Recruiting
    • Clinica Hildebrand Centro Ambulatoriale Lugano
    • Contact: Daria Dinacci; Phone Number: 0041 91 786 89 69; Email: d.dinacci@clinica-hildebrand.ch

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Informed Consent signed by the subject.
• Female and male patients between 18 and 90 years old
• Presence of an upper limb deficit derived from any disease or event that, according to the responsible clinicians, could be improved by therapy with ReHandyBot.

Exclusion Criteria:

• Pathologies that may interfere with the training with ReHandyBot.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: ReHandyBot; The therapy sessions with ReHandyBot (e.g., frequency, duration) will be scheduled based on the therapist's instruction and may vary between patients, depending on their specific needs.

Device: ReHandyBot; The ReHandyBot is a platform for hand rehabilitation with two degrees of freedom, namely forearm pronation/supination and finger flexion/extension. This device allows performing exercises targeting somatosensation and motor functions. Different exercises are implemented using virtual reality and haptic feedback; the interaction forces between subjects and ReHandyBot are measured by force sensors in the handles, allowing the control of a virtual hand and the physical interaction with the virtual environment. Mechanical properties (e.g., size, stiffness) of the objects displayed in the virtual environment are rendered by the motion/force of the instrumented handles. The type and difficulty level of the exercises are patient-specific and are automatically adapted throughout the therapy. The duration and frequency of the therapy sessions with ReHandyBot depend on the specific patient's needs and are set according to the therapist's instructions.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cost of ReHandyBot	Manufacturing costs of ReHandyBot and cost of its maintenance over the duration of the study in Swiss Francs (CHF). These costs are monitored by the manufacturer.	Monitored through study completion (expected duration: 5 years).
Cost of the clinical staff supporting therapy with ReHandyBot	Cost in Swiss Francs related to the clinical staff being present during the therapy sessions with ReHandyBot. This will be extrapolated from the software that the clinic uses to handle the schedules of the therapists. This cost is calculated by multiplying the number of therapy sessions with the device performed by the therapists of the clinic by the hourly rate of the therapists.	Monitored through study completion (expected duration: 5 years).
Number of supervised therapy sessions with ReHandyBot	Number of therapy sessions with ReHandyBot performed by the participants under the supervision of a therapist (i.e., 1-to-1 therapy sessions). This number is extrapolated from the software that the clinic uses to handle the schedules of the patients.	Monitored through study completion (expected duration: 5 years).
Number of minimally supervised therapy sessions with ReHandyBot	Number of therapy sessions with ReHandyBot performed by the participants under minimal supervision of a therapist (e.g., group sessions). This number is extrapolated from the software that the clinic uses to handle the schedules of the patients.	Monitored through study completion (expected duration: 5 years).
Number of unsupervised therapy sessions with ReHandyBot	Number of therapy sessions with ReHandyBot performed by the participants without the supervision of a therapist (i.e., the therapist is not present). This number is extrapolated from the software that the clinic uses to handle the schedules of the patients.	Monitored through study completion (expected duration: 5 years).
Patient-to-therapist ratio of the therapy sessions with ReHandyBot	Ratio of the number of patients to number of therapists present during the therapy sessions with ReHandyBot, where a higher ratio (i.e., multiple patients for one therapist) constitutes an economic benefit for the clinic. This ratio is extrapolated from the software of the clinic handling the schedules of patients and therapists.	Monitored through study completion (expected duration: 5 years).

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Feasibility of integrating ReHandyBot into the routine of a rehabilitation clinic: adverse events	Feasibility of integrating ReHandyBot into the routine of a rehabilitation clinic assessed as the number of adverse events related to the device.	Monitored through study completion (expected duration: 5 years).
Feasibility of integrating ReHandyBot into the routine of a rehabilitation clinic: device deficiencies	Feasibility of integrating ReHandyBot into the routine of a rehabilitation clinic assessed as the number of device deficiencies.	Monitored through study completion (expected duration: 5 years).
Feasibility of integrating ReHandyBot into the routine of a rehabilitation clinic: usage	Feasibility of integrating ReHandyBot into the routine of a rehabilitation clinic assessed as the usage (i.e., number of therapy sessions) of the device over time (i.e., if the device is no longer used after a short period, it means that it was not feasible to integrate it into the clinical routine of patients and therapists).	Monitored through study completion (expected duration: 5 years).
Intensity of use of ReHandyBot	Intensity of use of ReHandyBot, assessed as the number of hours per day when the device is occupied by a patient.	Monitored through study completion (expected duration: 5 years).
Increase in therapy dose: minutes	The increase in therapy dose in minutes for the patients using ReHandyBot minimally or unsupervised compared to usual care.	From participant's recruitment (day 0) until discharge from the clinic (on average: after 4 weeks).
Increase in therapy dose: percentage	The increase in physical therapy dose in percentage for the patients using ReHandyBot minimally or unsupervised compared to usual care.	From participant's recruitment (day 0) until discharge from the clinic (on average: after 4 weeks).
Quantity of patients training with ReHandyBot	Quantity of patients training with ReHandyBot expressed as the percentage of patients training with the device out of the total patients admitted to the clinic.	Monitored through study completion (expected duration: 5 years).
Characteristics of patients training with ReHandyBot	Characteristics (e.g., age, diagnosis) of patients training with ReHandyBot compared to the patients who are not eligible or able to train with ReHandyBot.	Monitored through study completion (expected duration: 5 years).
Reason why patients eventually stop training with ReHandyBot	Reason why an eligible patient eventually stops training with the device (e.g., due to not liking the device).	From participant's recruitment (day 0) until the last session performed with the device (on average: 4 weeks).
Evolution of patient's satisfaction with robot-assisted therapy as assessed by a 5-point scale	A 5-point scale is presented by the robot at the end of each therapy session to measure patient's satisfaction with robot-assisted therapy.	Monitored over the whole protocol duration (i.e., from the first to the last therapy session with ReHandyBot, on average 4 weeks).
Usability as assessed by the System Usability Scale	Usability of the ReHandyBot measured with the System Usability Scale. The possible response options vary between 1 (strongly disagree) and 5 (strongly agree).	Measured after two weeks from the first therapy session with ReHandyBot performed by a participant.
User experience - Net Promoter Score	The Net Promoter Score consists of the question "How likely would you be to recommend therapy with ReHandyBot to another patient?". The possible response options vary between 1 (extremely unlikely) and 10 (extremely likely).	Measured after two weeks from the first therapy session with ReHandyBot performed by a participant.

Collaborators and Investigators

• Sponsor: Swiss Federal Institute of Technology
• Collaborators: Clinica Hildebrand Brissago

Study record dates

Study Major Dates

• Study Start (Estimated): March 4, 2025
• Primary Completion (Estimated): December 30, 2030
• Study Completion (Estimated): December 30, 2030

Study Registration Dates

• First Submitted: November 28, 2024
• First Submitted That Met QC Criteria: December 4, 2024
• First Posted (Actual): December 10, 2024

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: March 3, 2025
• Last Verified: March 1, 2025

More Information

Terms related to this study

• Keywords: stroke; neurorehabilitation; upper limb rehabilitation; robot-assisted rehabilitation; unsupervised therapy; orthopaedic rehabilitation
• Other Study ID Numbers: RHB Clinic

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No