Impact of the robotic-assistance level on upper extremity function in stroke patients receiving adjunct robotic rehabilitation: sub-analysis of a randomized clinical trial.
Takashi Takebayashi, Kayoko Takahashi, Yuho Okita and 3 others
PMID 35216603WHAT IT FOUND
In 30 stroke patients using a robot, overall arm function change did not clearly differ between high and low assistance.
Higher assistance was linked with larger shoulder, elbow and task gains in severe weakness; lower assistance was linked with larger gains in milder weakness.
Key findings
01Total Fugl-Meyer change did not show a clear difference by assistance level and severity class (p = 0.103): severe-to-moderate patients changed 12.7 ± 9.8 points with high assistance and 8.0 ± 4.0 points with low assistance, while moderate-to-mild patients changed 3.8 ± 5.8 points with high assistance and 9.3 ± 6.2 points with low assistance.
02FMA-proximal change showed a difference by assistance level and severity class (p = 0.038): severe-to-moderate patients changed 7.8 ± 5.4 points with high assistance and 3.8 ± 3.3 points with low assistance, while moderate-to-mild patients changed 0.2 ± 1.5 points with high assistance and 3.8 ± 4.3 points with low assistance.
03Wolf Motor Function functional assessment change showed a difference by assistance level and severity class (p = 0.045): severe-to-moderate patients changed 9.3 ± 13.3 points with high assistance and -4.2 ± 8.2 points with low assistance, while moderate-to-mild patients changed -0.4 ± 8.3 points with high assistance and 11.4 ± 6.0 points with low assistance.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
This was an after-the-fact sub-analysis of only 30 patients from the robotic arm of an earlier trial, so it cannot establish that the assistance level caused the observed changes. The high- and low-assistance groups were formed after treatment from robot log data, not randomized before treatment. The authors did not adjust the multiple p-values for repeated testing, so some differences may have occurred by chance. The paper did not explain why 655 screened patients were excluded, so selection bias is possible. All patients also received conventional occupational therapy and standard rehabilitation, so the effect of the robot assistance level cannot be separated from those treatments. Patients were inpatient in Japan, 4-8 weeks after first stroke, with Brunnstrom stage III or IV, so the findings may not apply to outpatient, earlier, or more severely impaired patients. The analysis compared severity classes using FMA scores, but no robot-specific objective measures of assistance were used.
Declared interests
Funding was provided by Teijin Pharma Ltd., the company named with the ReoGo device in the article.
The easy way to misread this
Do not read the severity-specific changes as proof that changing robot assistance causes better recovery. The assistance groups were formed after treatment from robot logs, the sample was 30, the tests were not adjusted for multiple comparisons, and all patients also received conventional therapy.