Wang He, Wu Xiaoxu, Li Yaning, Yu Shaohong
Department of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China.
Department of Comprehensive Therapy, Qingdao Special Service Sanatorium of People's Liberation Army Navy, Qingdao, Shandong, China.
Arch Rehabil Res Clin Transl. 2024 Dec 17;7(1):100387. doi: 10.1016/j.arrct.2024.100387. eCollection 2025 Mar.
To systematically evaluate the efficacy of robot-assisted training (RAT) in the treatment of upper limb motor function in patients with stroke, and to compare the efficacy of different types of RAT.
We searched 5 English database (PubMed, Web of Science, Embase, Cochrane Library, and Scopus) and 4 Chinese databases (China National Knowledge Infrastructure [CNKI], SinoMed [CBM], VIP, and Wanfang Data) from inception to May 2024.
Randomized controlled trials (RCTs) of RAT combined with conventional rehabilitation therapy (CRT) on patients with upper extremity motor dysfunction after stroke. Two independent researches screened 3461 records, resulting in 31 eligible RCTs.
Two independent researches extracted data into a preformed table, including first author, year of publication, baseline characteristics of the literature (including sample size, age, disease duration, interventions, outcome indicators, and adverse reactions) and quality evaluation information.
Traditional meta-analysis and network meta-analysis were performed using RevMan 5.4 software and Stata 14.0 software, respectively. A total of 31 RCTs were included, involving 1537 patients. The results of traditional meta-analysis showed that in terms of upper limb function, RAT combined with RCT could effectively reduce the elbow flexion Modified Asworth Score (mean difference [MD] -0.63, 95% confidence interval (95% CI) -0.75 to -0.51), improve the Fugl-Meyer Assessment-upper extremity score (MD 5.92, 95% CI 3.52-8.32) and elbow extension angle (MD 16.14, 95% CI 14.56-17.73) in patients with stroke. In terms of activities of daily living, RAT combined with RCT could effectively improve the Modified Barthel Index score (MD 8.03, 95% CI 5.54-10.52) and Functional Independence Measure score (standardized MD 0.95, 95% CI 0.32-1.59) in patients with stroke. The results of network meta-analysis showed that the best probability of improving upper limb motor function was end-effector robot-assisted therapy (EE-RAT)>exoskeleton robot-assisted therapy (Exo-RAT)>CRT, and the best probability of improving daily living ability was Exo-RAT>EE-RAT>CRT.
The current evidence showed that RAT combined with routine rehabilitation therapy can effectively improve the upper limb motor function and activities of daily life of patients with stroke. Among them, the EE-RAT had the best effect in improving the upper limb motor function of patients with stroke, and the Exo-RAT had the best effect in improving the ability of daily life of patients with stroke.
系统评价机器人辅助训练（RAT）对脑卒中患者上肢运动功能的治疗效果，并比较不同类型RAT的疗效。
检索了5个英文数据库（PubMed、Web of Science、Embase、Cochrane图书馆和Scopus）以及4个中文数据库（中国知网[CNKI]、中国生物医学文献数据库[SinoMed][CBM]、维普和万方数据），检索时间从建库至2024年5月。
RAT联合传统康复治疗（CRT）用于脑卒中后上肢运动功能障碍患者的随机对照试验（RCT）。两名独立研究人员筛选了3461条记录，最终纳入31项符合条件的RCT。
两名独立研究人员将数据提取到一个预先设计的表格中，包括第一作者、发表年份、文献的基线特征（包括样本量、年龄、病程、干预措施、结局指标和不良反应）以及质量评价信息。
分别使用RevMan 5.4软件和Stata 14.0软件进行传统Meta分析和网状Meta分析。共纳入31项RCT，涉及1537例患者。传统Meta分析结果显示，在改善上肢功能方面，RAT联合CRT可有效降低脑卒中患者的肘关节屈曲改良Ashworth评分（平均差值[MD] -0.63，95%置信区间[95%CI] -0.75至-0.51），提高Fugl-Meyer评估上肢评分（MD 5.92，95%CI 3.52 - 8.32）和肘关节伸展角度（MD 16.14，95%CI 14.56 - 17.73）。在日常生活活动方面，RAT联合CRT可有效提高脑卒中患者的改良Barthel指数评分（MD 8.03，95%CI 5.54 - 10.52）和功能独立性测量评分（标准化MD 0.95，95%CI 0.32 - 1.59）。网状Meta分析结果显示，改善上肢运动功能的最佳概率为末端执行器机器人辅助治疗（EE-RAT）>外骨骼机器人辅助治疗（Exo-RAT）>CRT，改善日常生活能力的最佳概率为Exo-RAT>EE-RAT>CRT。
目前证据表明，RAT联合常规康复治疗可有效改善脑卒中患者的上肢运动功能和日常生活活动能力。其中，EE-RAT在改善脑卒中患者上肢运动功能方面效果最佳，Exo-RAT在改善脑卒中患者日常生活能力方面效果最佳。
