The Nethersole School of Nursing, The Chinese University of Hong Kond, New Territories, Hong Kong.
University of Bradford, Bradford, UK.
Brain Behav. 2020 Aug;10(8):e01742. doi: 10.1002/brb3.1742. Epub 2020 Jun 26.
Stroke survivors often experience upper-limb motor deficits and achieve limited motor recovery within six months after the onset of stroke. We aimed to systematically review the effects of robot-assisted therapy (RT) in comparison to usual care on the functional and health outcomes of subacute stroke survivors.
Randomized controlled trials (RCTs) published between January 1, 2000 and December 31, 2019 were identified from six electronic databases. Pooled estimates of standardized mean differences for five outcomes, including motor control (primary outcome), functional independence, upper extremity performance, muscle tone, and quality of life were derived by random effects meta-analyses. Assessments of risk of bias in the included RCTs and the quality of evidence for every individual outcomes were conducted following the guidelines of the Cochrane Collaboration.
Eleven RCTs involving 493 participants were included for review. At post-treatment, the effects of RT when compared to usual care on motor control, functional independence, upper extremity performance, muscle tone, and quality of life were nonsignificant (all ps ranged .16 to .86). The quality of this evidence was generally rated as low-to-moderate. Less than three RCTs assessed the treatment effects beyond post-treatment and the results remained nonsignificant.
Robot-assisted therapy produced benefits similar, but not significantly superior, to those from usual care for improving functioning and disability in patients diagnosed with stroke within six months. Apart from using head-to-head comparison to determine the effects of RT in subacute stroke survivors, future studies may explore the possibility of conducting noninferiority or equivalence trials, given that the less labor-intensive RT may offer important advantages over currently available standard care, in terms of improved convenience, better adherence, and lower manpower cost.
中风幸存者常出现上肢运动功能障碍，且在中风发病后 6 个月内运动功能恢复有限。本研究旨在系统评估机器人辅助疗法（RT）与常规治疗相比，对亚急性期中风幸存者的功能和健康结局的影响。
我们从六个电子数据库中确定了 2000 年 1 月 1 日至 2019 年 12 月 31 日发表的随机对照试验（RCT）。采用随机效应荟萃分析，得出了 5 项结局（主要结局为运动控制，包括运动控制、功能独立性、上肢运动表现、肌肉张力和生活质量）的标准化均数差值的汇总估计值。根据 Cochrane 协作的指南，对纳入的 RCT 进行了偏倚风险评估，并对每个单独结局的证据质量进行了评估。
纳入了 11 项 RCT 共 493 名参与者。在治疗后，与常规治疗相比，RT 对运动控制、功能独立性、上肢运动表现、肌肉张力和生活质量的影响无显著差异（所有 P 值范围为.16 至.86）。该证据质量总体评级为低到中度。少于 3 项 RCT 评估了治疗效果超过治疗后，结果仍然无显著差异。
在亚急性期中风幸存者中，与常规治疗相比，机器人辅助疗法在改善功能和残疾方面的效果相似，但并无显著优势。除了使用头对头比较来确定 RT 在亚急性期中风幸存者中的效果外，未来的研究可能会探索进行非劣效或等效试验的可能性，因为与目前可用的标准护理相比，劳动强度较低的 RT 在改善便利性、更好的依从性和降低人力成本方面可能具有重要优势。
