Effectiveness of robot-assisted training added to conventional rehabilitation in patients with humeral fracture early after surgical treatment: protocol of a randomised, controlled, multicentre trial

Abstract

Background: The incidence of proximal humeral fractures increases with age. The functional recovery of the upper arm after such fractures is slow, and results are often disappointing. Treatment is associated with long immobilisation periods. Evidence-based exercise guidelines are missing. Loss of muscle mass as well as reduced range of motion and motor performance are common consequences. These losses could be partly counteracted by training interventions using robot-assisted arm support of the affected arm derived from neurorehabilitation. Thus, shorter immobilisation could be reached. Thus far, this approach has been tested in only a few small studies. The aim of the present study is to examine whether assistive robotic training augmenting conventional occupational and physical therapy can improve functional shoulder outcomes.

Methods/design: Patients aged between 35 and 66 years with proximal humeral fracture and surgical treatment will be recruited at three different clinics in Germany and randomised into an intervention group and a control group. Participants will be assessed before randomisation and followed after completing an intervention period of 3 weeks and additionally after 3, 6 and 12 months. The baseline assessment will include cognition (Short Orientation-Memory-Concentration Test); level of pain in the affected arm; ability to work; gait speed (10-m walk); disability of the arm, shoulder and hand (Disabilities of the Arm, Shoulder and Hand Outcome Measure [DASH]); range of motion of the affected arm (goniometer measurement); visual acuity; and motor function of orthopaedic patients (Wolf Motor Function Test-Orthopaedic version [WMFT-O]). Clinical follow-up directly after the intervention will include assessment of disability of the arm, shoulder and hand (DASH) as well as range of motion and motor function (WMFT-O). The primary outcome parameter will be the DASH, and the secondary outcome parameter will be the WMFT-O. The long-term results will be assessed prospectively by postal follow-up. All patients will receive conventional occupational and physical therapy. The intervention group will receive additional robot-assisted training using the Armeo®Spring robot for 3 weeks.

Discussion: This study protocol describes a phase II, randomised, controlled, single-blind, multicentre intervention study. The results will guide and possibly improve methods of rehabilitation after proximal humeral fracture.

Trial registration: Clinicaltrials.gov, NCT03100201 . Registered on 28 March 2017.

Keywords: Humeral fracture; Randomised controlled study; Robot-assisted rehabilitation.

Conflict of interest statement

Ethics approval and consent to participate

For two of the three study sites (Robert-Bosch-Hospital Stuttgart and BG Trauma Centre Murnau), the study was approved by the ethics committee of the University of Tübingen (study number 381/2015BO1). For the BG Trauma Centre Ludwigshafen, the study was approved by the regional medical association of Rheinland-Pfalz (study number 837.519.15 [10287]). Potential protocol modifications will be communicated with these sites.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1

Plan of assessment and intervention procedures. DASH Disabilities of the Arm, Shoulder and Hand Outcome Measure, ROM Range of motion, WMFT-O Wolf Motor Function Test–Orthopaedic version

Fig. 2

a–l Armeo®Spring games

Fig. 3

Training schedule with games and directions of movement