Systematic review with network meta-analysis of randomized controlled trials of robotic-assisted arm training for improving activities of daily living and upper limb function after stroke.
Jan Mehrholz, Alex Pollock, Marcus Pohl and 2 others
PMID 32605587WHAT IT FOUND
No robotic arm training type improved daily living or arm function significantly more than others.
Indirect comparisons found no clear evidence to support choosing one specific device over another for stroke recovery.
Key findings
01Considering study heterogeneity, none of the intervention categories significantly improved activities of daily living measures.
02Considering study heterogeneity, none of the interventions significantly improved hand-arm functions.
03Indirect comparisons did not identify any one type of intervention which was significantly more effective at improving activities of daily living than any other type of intervention.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The description of the control group therapies was often poorly reported, which limits confidence in the indirect comparisons. The analysis for hand-arm strength was abandoned because the data from different studies were inconsistent. The study did not explore the impact of specific device features like actuation type or control mechanisms, only broad categories. Publication bias cannot be ruled out, as negative results may not have been published. The network lacked closed loops, meaning it was technically an adjusted indirect comparison rather than a full network meta-analysis.
Declared interests
There was no funding source for this study.
The easy way to misread this
Do not interpret the significant standardized mean differences for exoskeletons and unilateral proximal training as proof that these devices work better. These effects disappeared when the analysis accounted for the variability between the included studies.