Effects of Combining Robotic Assisted Therapy for Upper Limb With Other Therapeutic Approaches After Stroke: A Systematic Review and Meta-Analysis of Randomized Control Trials.

IF 1.5 Q3 REHABILITATION
Naoya Anmoto, Shiori Watanabe, Takao Kaneko, Masanori Maeda, Yuho Okita, Takashi Takebayashi
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引用次数: 0

Abstract

Background and purpose: Robotic-assisted therapy for the upper limb (RAT-UL) is a well-established, evidence-based approach to stroke rehabilitation. However, the effectiveness of combining RAT-UL with other therapeutic approaches remains unclear. This systematic review and meta-analysis, registered in PROSPERO (CRD42023422583), aimed to investigate the effect of combination therapy added to RAT-UL compared with RAT-UL alone on improving the motor function, and capacity of the affected upper limb and activity of daily living.

Methods: A systematic search was conducted in PubMed, CINAHL, Physiotherapy Evidence Database (PEDro), and Web of Science. We included randomized controlled trials (RCTs) published in English before October 2024. Methodological quality was assessed using the Cochrane risk of bias tool for RCTs. Meta-analysis was performed using RevMan 5.4 software. The primary inclusion criteria encompassed adults after stroke who underwent combining RAT-UL with other therapeutic approaches.

Results: After reviewing 5669 studies, we included 16 RCTs in this study. The overall effect of combining RAT-UL with other therapeutic approaches on the motor function in Fugl-Meyer Assessment was not significant improvement (MD = 1.40; 95% CI, 0.00-2.81; p = 0.05), whereas the differences on capacity of upper limb in Wolf Motor Function Test-Performance Time (MD = 0.48; 95% CI, 0.01-0.94; p = 0.04) and activities of daily living in the Functional Independence Measure were also observed (MD = 2.21; 95% CI, 0.12-4.31; p = 0.04). However, no significant differences were found in the analysis of activity levels in the ICF domains (SMD = 0.50; 95% CI, -1.33-2.34; p = 0.08). Subgroup analyses showed significant improvements in motor function in the Fugl-Meyer Assessment when partial substitution of RAT-UL with other high-intensity therapeutic approaches (MD = 3.42; 95% CI, 0.61-6.24; p = 0.02).

Discussion: Adding a high-intensity therapeutic approach to RAT-UL may lead to improvement in upper limb function and capacity compared with RAT-UL alone. However, the effectiveness of combining RAT-UL with other therapeutic approaches appears to vary depending on the type of adjunctive therapy employed. The effect sizes were small, and the findings across studies were inconsistent.

Trial registration: PROSPERO (CRD42023422583).

中风后上肢机器人辅助治疗与其他治疗方法相结合的效果:随机对照试验的系统回顾和荟萃分析。
背景和目的:上肢机器人辅助治疗(RAT-UL)是一种完善的、基于证据的中风康复方法。然而,RAT-UL联合其他治疗方法的有效性尚不清楚。这项在PROSPERO (CRD42023422583)上注册的系统综述和荟萃分析,旨在探讨与单独使用RAT-UL相比,联合使用RAT-UL治疗对改善运动功能、受损上肢能力和日常生活活动的影响。方法:系统检索PubMed、CINAHL、物理治疗证据数据库(PEDro)和Web of Science。我们纳入了2024年10月前以英文发表的随机对照试验(RCTs)。采用Cochrane随机对照试验偏倚风险工具评估方法学质量。采用RevMan 5.4软件进行meta分析。主要纳入标准包括卒中后接受RAT-UL联合其他治疗方法的成年人。结果:在回顾了5669项研究后,我们纳入了16项rct。在Fugl-Meyer评估中,RAT-UL联合其他治疗方法对运动功能的总体效果无显著改善(MD = 1.40;95% ci, 0.00-2.81;p = 0.05),而上肢能力在Wolf运动功能测试执行时间上的差异(MD = 0.48;95% ci, 0.01-0.94;p = 0.04),在功能独立测量中也观察到日常生活活动(MD = 2.21;95% ci, 0.12-4.31;p = 0.04)。然而,在ICF区域的活动水平分析中没有发现显著差异(SMD = 0.50;95% ci, -1.33-2.34;p = 0.08)。亚组分析显示,当用其他高强度治疗方法部分替代RAT-UL时,Fugl-Meyer评估中的运动功能有显著改善(MD = 3.42;95% ci, 0.61-6.24;p = 0.02)。讨论:与单独使用RAT-UL相比,在RAT-UL中加入高强度治疗方法可能导致上肢功能和能力的改善。然而,将RAT-UL与其他治疗方法联合使用的有效性似乎因所采用的辅助治疗类型而异。效应量很小,研究结果也不一致。试验注册:PROSPERO (CRD42023422583)。
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来源期刊
CiteScore
3.30
自引率
5.90%
发文量
53
期刊介绍: Physiotherapy Research International is an international peer reviewed journal dedicated to the exchange of knowledge that is directly relevant to specialist areas of physiotherapy theory, practice, and research. Our aim is to promote a high level of scholarship and build on the current evidence base to inform the advancement of the physiotherapy profession. We publish original research on a wide range of topics e.g. Primary research testing new physiotherapy treatments; methodological research; measurement and outcome research and qualitative research of interest to researchers, clinicians and educators. Further, we aim to publish high quality papers that represent the range of cultures and settings where physiotherapy services are delivered. We attract a wide readership from physiotherapists and others working in diverse clinical and academic settings. We aim to promote an international debate amongst the profession about current best evidence based practice. Papers are directed primarily towards the physiotherapy profession, but can be relevant to a wide range of professional groups. The growth of interdisciplinary research is also key to our aims and scope, and we encourage relevant submissions from other professional groups. The journal actively encourages submissions which utilise a breadth of different methodologies and research designs to facilitate addressing key questions related to the physiotherapy practice. PRI seeks to encourage good quality topical debates on a range of relevant issues and promote critical reflection on decision making and implementation of physiotherapy interventions.
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