The effectiveness of robotic therapy in reducing upper limb spasticity in stroke survivors: a systematic review and meta-analysis.

All included trials were judged at high risk for performance bias because participants and therapists could not be blinded. Many trials did not clearly report allocation concealment, so selection bias cannot be ruled out. The certainty for wrist, shoulder, unspecified and hand-device spasticity results was low or very low. Robot type, dose, timing, and whether robotics replaced or added to conventional therapy varied widely. The main spasticity measure was the Modified Ashworth Scale, which limits conclusions about physiological tone changes. Adverse event reporting was incomplete, and the certainty for safety was very low. The search was limited to English-language publications.

Do not use robotic therapy mainly as an anti-spasticity intervention. The reductions were small, not seen for shoulder adductors or hand-only devices, and the review positions robotics as a way to increase motor practice rather than a primary tone treatment.