New technologies promoting active upper limb rehabilitation after stroke: an overview and network meta-analysis.
Gauthier Everard, Louise Declerck, Christine Detrembleur and 4 others
PMID 35666491WHAT IT FOUND
Virtual reality and robot-assisted therapy improved upper-limb motor function more than conventional therapy in both subacute and chronic stroke.
Telerehabilitation matched conventional therapy. Choose robots for severe impairment early on, and virtual reality for milder cases or later stages.
Key findings
01In the subacute phase, virtual reality, robot-assisted therapy, and telerehabilitation all improved motor function significantly more than conventional therapy.
02In the chronic phase, virtual reality and robot-assisted therapy improved motor function more than conventional therapy, but telerehabilitation showed no significant difference.
03Robot-assisted therapy showed the greatest benefit for patients with severe-moderate impairments in the subacute phase, while virtual reality was most effective for those with moderate-mild impairments.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The certainty of evidence ranged from very low to moderate depending on the specific outcome and phase. High heterogeneity between studies in some analyses, particularly for robot-assisted therapy when substituted for conventional therapy. No direct comparisons existed between the technologies themselves, relying on indirect network estimates. Virtual reality and telerehabilitation require a baseline level of motor and cognitive function, limiting generalizability to patients with severe hemiplegia or significant aphasia/apraxia.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not assume telerehabilitation is superior to conventional therapy for chronic stroke patients; it was found to be equivalent for motor function and activity in this phase. Also, virtual reality is not suitable for patients with severe motor impairments who cannot initiate movement, as it does not provide physical assistance.