Efficacy of wrist robot-aided orthopedic rehabilitation: a randomized controlled trial

Abstract

Background: In recent years, many studies focused on the use of robotic devices for both the assessment and the neuro-motor reeducation of upper limb in subjects after stroke, spinal cord injuries or affected by neurological disorders. Contrarily, it is still hard to find examples of robot-aided assessment and rehabilitation after traumatic injuries in the orthopedic field. However, those benefits related to the use of robotic devices are expected also in orthopedic functional reeducation.

Methods: After a wrist injury occurred at their workplace, wrist functionality of twenty-three subjects was evaluated through a robot-based assessment and clinical measures (Patient Rated Wrist Evaluation, Jebsen-Taylor and Jamar Test), before and after a 3-week long rehabilitative treatment. Subjects were randomized in two groups: while the control group (n = 13) underwent a traditional rehabilitative protocol, the experimental group (n = 10) was treated replacing traditional exercises with robot-aided ones.

Results: Functionality, assessed through the function subscale of PRWE scale, improved in both groups (experimental p = 0.016; control p < 0.001) and was comparable between groups, both pre (U = 45.5, p = 0.355) and post (U = 47, p = 0.597) treatment. Additionally, even though groups' performance during the robotic assessment was comparable before the treatment (U = 36, p = 0.077), after rehabilitation the experimental group presented better results than the control one (U = 26, p = 0.015).

Conclusions: This work can be considered a starting point for introducing the use of robotic devices in the orthopedic field. The robot-aided rehabilitative treatment was effective and comparable to the traditional one. Preserving efficacy and safety conditions, a systematic use of these devices could lead to decrease human therapists' effort, increase repeatability and accuracy of assessments, and promote subject's engagement and voluntary participation. Trial Registration ClinicalTrial.gov ID: NCT04739644. Registered on February 4, 2021-Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/study/NCT04739644 .

Keywords: Orthopedic; Robotic assessment; Robotic rehabilitation; Wrist injury.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1

The experimental setup. Subjects’ placement and virtual reality during an illustrative example of a tracking task

Fig. 2

The experimental protocol

Fig. 3

Median values and IQR of clinical tests scores. Panels presented results for Jamar Test (A), Jebsen-Taylor test (B), PRWE subscale pain (C) and PRWE subscale function (D). Grey and black lines stay for control and experimental group, respectively. Significant results in Wilcoxon Matched Pairs tests (p < 0.05) are identified by a “*”, black or grey depending on the tested group

Fig. 4

Median values and IQR of Robotic Assessment Index. Grey and black lines stay for control and experimental group, respectively. Significant results in Wilcoxon Matched Pairs tests are identified by a “*”, black for the experimental group and grey for the control one. Red “*” identified significant differences found after independent Mann–Whitney U tests

Fig. 5

Median values of passive (A) and active (B) ROM. Black and grey lines stay for experimental and control group, respectively. Dotted and solid lines stay for Tb and Te assessment, respectively. Red dotted lines represented data used to normalize each direction, i.e., the best and worst performance (xbest and xworst) found along that specific direction, among all the subjects and evaluations

Fig. 6

Median values of passive (A and C) and active (B and D) ROM for pronation (A and B) and supination movements (C and D). Black and grey stay for experimental and control group, respectively. Red dotted lines represented data used to normalize each direction, i.e., the best and worst performance (xbest and xworst) found along that specific direction, among all the subjects and evaluations

Fig. 7

Median values of isometric force. A showed directions on the FE-RUD space, while B, C pronation and supination direction, respectively. Black and grey lines stay for experimental and control group, respectively. In panel A dotted and solid lines stay for Tb and Te assessment, respectively. Red dotted lines represented data used to normalize each direction, i.e., the best and worst performance (xbest and xworst) found along that specific direction, among all the subjects and evaluations

Fig. 8

Median values of matching error. A showed directions on the FE-RUD space, while B, C pronation and supination direction, respectively. Black and grey lines stay for experimental and control group, respectively. In panel A dotted and solid lines stay for Tb and Te assessment, respectively. Red dotted lines represented data used to normalize each direction, i.e., the best and worst performance (xbest and xworst) found along that specific direction, among all the subjects and evaluations