Rehabilitation Hospital affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, China.
Fujian Key Laboratory of Rehabilitation Technology, Fuzhou, Fujian, China.
Phys Ther. 2021 Apr 4;101(4). doi: 10.1093/ptj/pzab010.
The purpose of this study was to review the effects of robot-assisted therapy (RT) for improving poststroke upper extremity motor impairment.
The PubMed, Embase, Medline, and Web of Science databases were searched from inception to April 8, 2020. Randomized controlled trials that were conducted to evaluate the effects of RT on upper extremity motor impairment poststroke and that used Fugl-Meyer assessment for upper extremity scores as an outcome were included. Two authors independently screened articles, extracted data, and assessed the methodological quality of the included studies using the Physiotherapy Evidence Database (PEDro) scale. A random-effects meta-analysis was performed to pool the effect sizes across the studies.
Forty-one randomized controlled trials with 1916 stroke patients were included. Compared with dose-matched conventional rehabilitation, RT significantly improved the Fugl-Meyer assessment for upper extremity scores of the patients with stroke, with a small effect size (Hedges g = 0.25; 95% CI, 0.11-0.38; I2 = 45.9%). The subgroup analysis revealed that the effects of unilateral RT, but not that of bilateral RT, were superior to conventional rehabilitation (Hedges g = 0.32; 95% CI, 0.15-0.50; I2 = 55.9%). Regarding the type of robot devices, the effects of the end effector device (Hedges g = 0.22; 95% CI, 0.09-0.36; I2 = 35.4%), but not the exoskeleton device, were superior to conventional rehabilitation. Regarding the stroke stage, the between-group difference (ie, RT vs convention rehabilitation) was significant only for people with late subacute or chronic stroke (Hedges g = 0.33; 95% CI, 0.16-0.50; I2 = 34.2%).
RT might be superior to conventional rehabilitation in improving upper extremity motor impairment in people after stroke with notable upper extremity hemiplegia and limited potential for spontaneous recovery.
本研究旨在回顾机器人辅助疗法（RT）对改善脑卒中后上肢运动障碍的效果。
从建库至 2020 年 4 月 8 日，我们检索了 PubMed、Embase、Medline 和 Web of Science 数据库。纳入了评估 RT 对脑卒中后上肢运动障碍影响的随机对照试验，并且将 Fugl-Meyer 上肢评分作为结局指标。两位作者独立筛选文献、提取数据，并使用 Physiotherapy Evidence Database（PEDro）量表评估纳入研究的方法学质量。采用随机效应荟萃分析汇总各研究的效应量。
纳入了 41 项随机对照试验，共计 1916 例脑卒中患者。与剂量匹配的常规康复相比，RT 显著改善了脑卒中患者的 Fugl-Meyer 上肢评分，效应量较小（Hedges g=0.25；95%CI，0.11-0.38；I2=45.9%）。亚组分析显示，单侧 RT 的效果优于常规康复（Hedges g=0.32；95%CI，0.15-0.50；I2=55.9%），但双侧 RT 的效果不优于常规康复。关于机器人设备的类型，末端执行器设备（Hedges g=0.22；95%CI，0.09-0.36；I2=35.4%）的效果优于常规康复，但外骨骼设备的效果并不优于常规康复。关于脑卒中的阶段，仅在亚急性或慢性晚期脑卒中患者中，组间差异（即 RT 与常规康复）有统计学意义（Hedges g=0.33；95%CI，0.16-0.50；I2=34.2%）。
对于上肢偏瘫明显且自发恢复潜力有限的脑卒中患者，RT 可能优于常规康复，可改善上肢运动障碍。
