Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke

Abstract

Background: Electromechanical and robot-assisted arm training devices are used in rehabilitation, and may help to improve arm function after stroke.

Objectives: To assess the effectiveness of electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength in people after stroke. We also assessed the acceptability and safety of the therapy.

Search methods: We searched the Cochrane Stroke Group's Trials Register (last searched January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2018, Issue 1), MEDLINE (1950 to January 2018), Embase (1980 to January 2018), CINAHL (1982 to January 2018), AMED (1985 to January 2018), SPORTDiscus (1949 to January 2018), PEDro (searched February 2018), Compendex (1972 to January 2018), and Inspec (1969 to January 2018). We also handsearched relevant conference proceedings, searched trials and research registers, checked reference lists, and contacted trialists, experts, and researchers in our field, as well as manufacturers of commercial devices.

Selection criteria: Randomised controlled trials comparing electromechanical and robot-assisted arm training for recovery of arm function with other rehabilitation or placebo interventions, or no treatment, for people after stroke.

Data collection and analysis: Two review authors independently selected trials for inclusion, assessed trial quality and risk of bias, used the GRADE approach to assess the quality of the body of evidence, and extracted data. We contacted trialists for additional information. We analysed the results as standardised mean differences (SMDs) for continuous variables and risk differences (RDs) for dichotomous variables.

Main results: We included 45 trials (involving 1619 participants) in this update of our review. Electromechanical and robot-assisted arm training improved activities of daily living scores (SMD 0.31, 95% confidence interval (CI) 0.09 to 0.52, P = 0.0005; I² = 59%; 24 studies, 957 participants, high-quality evidence), arm function (SMD 0.32, 95% CI 0.18 to 0.46, P < 0.0001, I² = 36%, 41 studies, 1452 participants, high-quality evidence), and arm muscle strength (SMD 0.46, 95% CI 0.16 to 0.77, P = 0.003, I² = 76%, 23 studies, 826 participants, high-quality evidence). Electromechanical and robot-assisted arm training did not increase the risk of participant dropout (RD 0.00, 95% CI -0.02 to 0.02, P = 0.93, I² = 0%, 45 studies, 1619 participants, high-quality evidence), and adverse events were rare.

Authors' conclusions: People who receive electromechanical and robot-assisted arm training after stroke might improve their activities of daily living, arm function, and arm muscle strength. However, the results must be interpreted with caution although the quality of the evidence was high, because there were variations between the trials in: the intensity, duration, and amount of training; type of treatment; participant characteristics; and measurements used.

Conflict of interest statement

Jan Mehrholz: was a coauthor of one included trial (Hesse 2005). He did not participant in the quality assessment or data extraction of this study. Marcus Pohl: was a coauthor of one included trial (Hesse 2005). He did not participant in the quality assessment or data extraction of this study. Thomas Platz: none known. Joachim Kugler: none known. Bernhard Elsner: none known.

Figures

1

Study flow diagram. Please note that several studies have been published in multiple full‐text articles. Hence the number of assessed full‐text articles and the number of identified studies may differ.

2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

3

Funnel plot of comparison: 1 Electromechanical and robotic assisted training versus all other intervention, outcome: 1.1 Activities of daily living at the end of intervention phase.

4

Funnel plot of comparison: 1 Electromechanical and robotic assisted training versus all other intervention, outcome: 1.2 Activities of daily living at the end of intervention phase: subgroup analysis comparing acute and chronic phase.

5

Funnel plot of comparison: 1 Electromechanical and robotic assisted training versus all other intervention, outcome: 1.3 Arm function at the end of intervention phase.

6

Funnel plot of comparison: 1 Electromechanical and robotic assisted training versus all other intervention, outcome: 1.4 Arm muscle strength at the end of intervention phase.