Effects of Balance Exercise Assist Robot training for patients with hemiparetic stroke: a randomized controlled trial.
Seigo Inoue, Yohei Otaka, Masashi Kumagai and 3 others
PMID 35090517WHAT IT FOUND
Adding 18 minutes of balance training six times a week to usual inpatient rehabilitation improved balance more than usual rehabilitation alone.
A robot did it no better than a therapist, though patients enjoyed the robot more. Strength, walking independence and daily function did not differ.
Key findings
01Adding either robot balance training or therapist-led intensive balance training to usual rehabilitation improved dynamic balance more than usual rehabilitation alone. Mean gains on the balance test were 3.5 and 3.4 points at the end of training and 5.4 and 5.2 points at follow-up, against 1.2 and 1.9 points with usual rehabilitation alone.
02The robot was no better than the dose-matched therapist-led balance programme on the balance test. Apart from the timed rise-walk-turn test straight after training, none of the secondary measures differed between groups at either assessment.
03Patients rated the robot training as more enjoyable than the therapist-led programme, scoring it 8.4 against 6.3 on a scale where 5 meant no different from ordinary walking practice. Ratings of how much they wanted to keep going were 7.6 against 5.7, which did not reach significance.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
One hospital in Japan, and only patients in the subacute phase after a first stroke. It says nothing about chronic stroke, about community or outpatient settings, or about the robot in other hands. Everyone was excluded if they could not follow instructions because of aphasia or cognitive problems, and anyone already balancing reasonably well was excluded too. Your more impaired and your more able patients are not represented here. Follow-up ended 2 weeks after training stopped, so nothing here tells you whether the advantage lasts. The groups were not alike to begin with. The usual-care group was older and the therapist-led group was mostly male. The analysis adjusted for age and sex, and the authors say they cannot be sure the adjustment removed the effect. The study was sized to detect a difference in the total balance score, not in its four components. The finding that only the robot group improved at reacting to a push comes from an underpowered comparison, even though the authors defend it. Of the 60 randomised, 57 finished training and only 48 were assessed at follow-up, so the follow-up numbers rest on fewer patients than the headline count. Patients and treating staff obviously knew which training they were getting. Only the assessors were blind, and the enjoyment ratings are self-reported by unblinded patients comparing a video game with floor exercises.
Declared interests
The text supplied carries no funding statement and no competing-interest declaration. Worth knowing anyway: the robot tested is made by Toyota Motor Corporation, and the trial was run at a single rehabilitation hospital that had the device.
The easy way to misread this
Do not read this as evidence that the robot beats a therapist. The robot group and the therapist-led group made almost identical gains on the balance test, and the robot's only clear advantage was that patients said they enjoyed it more. The usual-care group also improved significantly on its own, so the extra balance training added to a picture that was already improving.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →