Amirbekova Mariyam, Kispayeva Tokzhan, Adomaviciene Ausra, Eszhanova Laura, Bolshakova Inna, Ospanova Zhanna
Institute of Life Sciences, Karaganda Medical University, Karaganda, Kazakhstan.
School of Nursing Education, Karaganda Medical University, Karaganda, Kazakhstan.
Front Hum Neurosci. 2025 Jul 21;19:1622661. doi: 10.3389/fnhum.2025.1622661. eCollection 2025.
BACKGROUND: Stroke is a leading cause of adult disability worldwide, often resulting in persistent motor impairments. While conventional rehabilitation approaches often yield modest results, robotic-assisted therapy has emerged as a promising solution to enhance motor recovery. However, the impact of stroke phase (acute, subacute, chronic) and other clinical modifiers on the effectiveness of robotic rehabilitation remains underexplored. METHODS: The protocol for this systematic review and meta-analysis was registered in PROSPERO under the registration number CRD420251038754. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. The literature search was conducted using MEDLINE, PubMed, Cochrane Library, Scopus, Web of Science, and EMBASE. Risk of bias was assessed using the RoB 2.0. Primary outcomes included motor recovery, gait speed, and balance. A random-effects model (DerSimonian-Laird) was applied to calculate pooled standardized mean differences (SMD), and subgroup analyses and meta-regression were used to assess the influence of stroke phase, age, therapy duration, and combined interventions (e.g., virtual reality, mirror therapy). RESULTS: Thirteen randomized controlled trials (RCTs) published between 2015 and 2025 were included, with a total of 424 post-stroke patients. Robotic therapy showed a moderate but statistically significant effect over conventional rehabilitation (SMD = 0.59, 95% CI: [0.33; 0.84], < 0.001), with low-to-moderate heterogeneity (I = 30.5%). Subgroup analysis revealed the strongest effects during the subacute phase (SMD = 0.74) and acute phase (SMD = 0.75), while the chronic phase yielded limited improvement (SMD = 0.23). Younger age and a intervention duration of more than 6 weeks were associated with enhanced outcomes. Meta-regression indicated a trend toward reduced effectiveness with prolonged intervention duration ( = -0.134), although not statistically significant ( = 0.102). No publication bias was detected (Egger's = 0.56). CONCLUSION: Robotic-assisted therapy provides clinically meaningful improvements in post-stroke motor recovery. The findings support early stratification and personalization of rehabilitation programs based on stroke timing, age, and intervention intensity. Integration of robotic systems with virtual and cognitive components may further enhance neuroplasticity, leading to improved functional outcomes. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251038754.
背景:中风是全球成人残疾的主要原因,常导致持续性运动障碍。虽然传统康复方法往往效果有限,但机器人辅助治疗已成为促进运动恢复的一种有前景的解决方案。然而,中风阶段(急性、亚急性、慢性)和其他临床因素对机器人康复效果的影响仍未得到充分研究。 方法:本系统评价和荟萃分析的方案已在PROSPERO注册,注册号为CRD420251038754。按照PRISMA指南进行系统评价和荟萃分析。使用MEDLINE、PubMed、Cochrane图书馆、Scopus、科学网和EMBASE进行文献检索。使用RoB 2.0评估偏倚风险。主要结局包括运动恢复、步速和平衡。应用随机效应模型(DerSimonian-Laird)计算合并标准化均数差(SMD),并进行亚组分析和meta回归以评估中风阶段、年龄、治疗持续时间和联合干预(如虚拟现实、镜像疗法)的影响。 结果:纳入了2015年至2025年间发表的13项随机对照试验(RCT),共424例中风后患者。机器人治疗相对于传统康复显示出中等但具有统计学意义的效果(SMD = 0.59,95% CI:[0.33; 0.84],P < 0.001),异质性低至中等(I² = 30.5%)。亚组分析显示,在亚急性阶段(SMD = 0.74)和急性阶段(SMD = 0.75)效果最强,而慢性阶段改善有限(SMD = 0.23)。年龄较小和干预持续时间超过6周与更好的结局相关。Meta回归表明,随着干预持续时间延长,效果有降低趋势(β = -0.134),但无统计学意义(P = 0.102)。未检测到发表偏倚(Egger's P = 0.56)。 结论:机器人辅助治疗在中风后运动恢复方面提供了具有临床意义的改善。研究结果支持根据中风时间、年龄和干预强度对康复计划进行早期分层和个性化。将机器人系统与虚拟和认知组件相结合可能进一步增强神经可塑性,从而改善功能结局。 系统评价注册:https://www.crd.york.ac.uk/PROSPERO/view/CRD420251038754。
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