Hwang Sujin, Min Kyoung-Chul, Song Chiang-Soon
Department of Physical Therapy, Division of Health Science, Baekseok University, Cheonan, Republic of Korea; Graduate School of Health Welfare, Baekseok University, Seoul, Republic of Korea.
Department of Occupational Therpay, Wonkwang University, Republic of Korea.
J Hand Ther. 2024 Oct-Dec;37(4):507-519. doi: 10.1016/j.jht.2023.12.014. Epub 2024 May 24.
In stroke rehabilitation, the selection of appropriate assistive devices is of paramount importance for patients. Specifically, the choice of device can significantly influence the functional recovery of the upper limb, impacting their overall activities or functional tasks.
This review aimed to comprehensively analyze and summarize the clinical evidence from randomized controlled trials (RCTs) regarding the therapeutic effects of commonly used assistive devices on upper extremity function in patients with stroke.
To evaluate assistive devices for patients with stroke, we summarized qualitatively throughout synthesis of results, such as therapeutic intervention, intensity, outcome, and summary of results, and examined risk of bias, heterogeneity, mean difference, 95% confidence interval, and I-squared value. To analyze, we used RoB 2 and RevMan 5.4.
The qualitative synthesis included 31 RCTs. The randomization process and the reporting of results showed minimal bias, but there were issues with bias from intended interventions, and missing outcome data presented some concerns. The quantitative synthesis included 16 RCTs. There was a significant difference in the Fugl-Meyer assessment-upper extremity functioning (FMA-UE) scores between the groups, with a total mean difference (95% confidence interval) of 2.40 (0.21, 4.60), heterogeneity values were Tau = 0.32, chi-square = 8.22, degrees of freedom = 8 (p = 0.41), and I = 3% for FMA-UE and the test for the overall effect produced Z = 2.14 (p = 0.03) in patients with chronic stroke. However, there was no significant difference in all other outcome measures.
Upper-limb robots did not demonstrate significant superiority over conventional treatments in improving function of upper limbs, with the exception of FMA-UE scores for patients with chronic stroke. The mean difference of FMA-UE was also lower than minimally important difference. Nonetheless, the usage of upper-limb robots may contribute to enhanced function for patients with stroke, as those devices support clinicians and enable a greater number of movement repetitions within specific time frames.
在中风康复中，为患者选择合适的辅助设备至关重要。具体而言，设备的选择会显著影响上肢的功能恢复，进而影响患者的整体活动或功能任务。
本综述旨在全面分析和总结来自随机对照试验（RCT）的临床证据，这些证据涉及常用辅助设备对中风患者上肢功能的治疗效果。
为评估中风患者的辅助设备，我们在综合结果时进行了定性总结，包括治疗干预、强度、结果和结果总结，并检查了偏倚风险、异质性、平均差异、95%置信区间和I²值。为进行分析，我们使用了RoB 2和RevMan 5.4。
定性综合分析纳入了31项随机对照试验。随机化过程和结果报告显示偏倚最小，但意向性干预存在偏倚问题，且缺失的结果数据令人担忧。定量综合分析纳入了16项随机对照试验。两组之间的Fugl-Meyer评估上肢功能（FMA-UE）评分存在显著差异，总平均差异（95%置信区间）为2.40（0.21，4.60），FMA-UE的异质性值为Tau = 0.32，卡方 = 8.22，自由度 = 8（p = 0.41），I = 3%，总体效应检验在慢性中风患者中产生Z = 2.14（p = 0.03）。然而，所有其他结局指标均无显著差异。
除慢性中风患者的FMA-UE评分外，上肢机器人在改善上肢功能方面并未显示出比传统治疗有显著优势。FMA-UE的平均差异也低于最小重要差异。尽管如此，上肢机器人的使用可能有助于中风患者增强功能，因为这些设备可辅助临床医生，并能在特定时间范围内实现更多的运动重复。
