دورية أكاديمية
Upper Limb Robots for Recovery of Motor Arm Function in Patients With Stroke: A Systematic Review and Meta-Analysis.
| العنوان: | Upper Limb Robots for Recovery of Motor Arm Function in Patients With Stroke: A Systematic Review and Meta-Analysis. |
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| المؤلفون: | De Iaco L; From the IRCCS Fondazione Don Gnocchi (L.D.I.), Milan, Italy; Neurocenter (J.M.V.), Luzerner Kantonsspital, Lucerne, Switzerland; Medical Library (J.C.F.K.), Amsterdam University Medical Centre, Department of Rehabilitation Medicine (G.K.), Amsterdam University Medical Centre, Amsterdam Movement Sciences, Amsterdam Neuroscience, the Netherlands; and Department of Physical Therapy and Human Movement Sciences (G.K.), Feinberg School of Medicine, North-Western University, Chicago, IL., Veerbeek JM; From the IRCCS Fondazione Don Gnocchi (L.D.I.), Milan, Italy; Neurocenter (J.M.V.), Luzerner Kantonsspital, Lucerne, Switzerland; Medical Library (J.C.F.K.), Amsterdam University Medical Centre, Department of Rehabilitation Medicine (G.K.), Amsterdam University Medical Centre, Amsterdam Movement Sciences, Amsterdam Neuroscience, the Netherlands; and Department of Physical Therapy and Human Movement Sciences (G.K.), Feinberg School of Medicine, North-Western University, Chicago, IL., Ket JCF; From the IRCCS Fondazione Don Gnocchi (L.D.I.), Milan, Italy; Neurocenter (J.M.V.), Luzerner Kantonsspital, Lucerne, Switzerland; Medical Library (J.C.F.K.), Amsterdam University Medical Centre, Department of Rehabilitation Medicine (G.K.), Amsterdam University Medical Centre, Amsterdam Movement Sciences, Amsterdam Neuroscience, the Netherlands; and Department of Physical Therapy and Human Movement Sciences (G.K.), Feinberg School of Medicine, North-Western University, Chicago, IL., Kwakkel G; From the IRCCS Fondazione Don Gnocchi (L.D.I.), Milan, Italy; Neurocenter (J.M.V.), Luzerner Kantonsspital, Lucerne, Switzerland; Medical Library (J.C.F.K.), Amsterdam University Medical Centre, Department of Rehabilitation Medicine (G.K.), Amsterdam University Medical Centre, Amsterdam Movement Sciences, Amsterdam Neuroscience, the Netherlands; and Department of Physical Therapy and Human Movement Sciences (G.K.), Feinberg School of Medicine, North-Western University, Chicago, IL. |
| المصدر: | Neurology [Neurology] 2024 Jul 23; Vol. 103 (2), pp. e209495. Date of Electronic Publication: 2024 Jun 13. |
| نوع المنشور: | Journal Article; Systematic Review; Meta-Analysis |
| اللغة: | English |
| بيانات الدورية: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0401060 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1526-632X (Electronic) Linking ISSN: 00283878 NLM ISO Abbreviation: Neurology Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Hagerstown, MD : Lippincott Williams & Wilkins Original Publication: Minneapolis. |
| مواضيع طبية MeSH: | Stroke Rehabilitation*/methods , Stroke Rehabilitation*/instrumentation , Robotics* , Recovery of Function*/physiology , Upper Extremity*/physiopathology, Humans ; Stroke/physiopathology ; Stroke/complications ; Randomized Controlled Trials as Topic |
| مستخلص: | Background and Objectives: Robot technology to support upper limb (UL) rehabilitation poststroke has rapidly developed over the past 3 decades. We aimed to assess the effects of UL-robots (UL-RTs) on recovery of UL motor functioning and capacity poststroke when compared with any non-UL-RT and to identify variables that are associated with the found effect sizes (ESs). Methods: Randomized controlled trials (RCTs) comparing UL-RTs with any other intervention on patients with UL limitations poststroke were identified in electronic searches from PubMed, Wiley/Cochrane Libraries, Embase, Cumulative Index of Nursing and Allied Health Literature, Web of Science, SportDISCUS, Physiotherapy Evidence Database (PEDro), and Google Scholar from inception until August 1, 2022. Two reviewers independently extracted relevant data using a Microsoft Excel spreadsheet. Meta-analyses were performed for measures of UL-muscle synergism, muscle power, muscle tone, capacity, self-reported motor performance, and basic activities of daily living (ADLs). Subgroup, sensitivity, and meta-regression analyses were applied to identify factors potentially associated with found ESs. Analyses were performed using Review Manager version 5.4 or IBM SPSS statistics version 27. Results: Ninety RCTs (N = 4,311) were included (median PEDro score 6 [6-7]). Meta-analyses of 86 trials (N = 4,240) showed small significant improvements in UL-muscle synergism (Fugl-Meyer Assessment of the UL [FM-UL]) (mean difference 2.23 [1.11-3.35]), muscle power (standardized mean difference [SMD] 0.39 [0.16-0.61]), motor performance (SMD 0.11 [0.00-0.21]), and basic ADLs (SMD 0.28 [0.10-0.45]). No overall effects were found for muscle tone (SMD -0.1 [-0.26 to 0.07]) or UL-capacity (SMD 0.04 [-0.10 to 0.18]), except with exoskeletons (SMD 0.27 [0.10-0.43]). Meta-regressions showed a significant positive association between baseline mean FM-UL and ESs for UL-capacity ( r = 0.339; p = 0.03), in particular in the acute and early-subacute phases poststroke ( r = 0.65; p = 0.01). No further significant subgroup differences or associations were found in our analyses. Discussion: The small significant effects found at the level of motor impairment do not show generalization to clinically meaningful effects at the level of UL-capacity. Meta-regressions suggest that selected participants with some potential of UL-recovery may benefit most from UL-RT, especially earlier poststroke. The robustness and consistency of our findings suggest that the development of the next generation of UL-RT needs to be guided by a better mechanistic understanding about assumed underlying interaction effects between motor learning and motor recovery poststroke. Trial Registration Information: A prospectively registered study protocol is available in the PROSPERO database under ID CRD42020197450. |
| تواريخ الأحداث: | Date Created: 20240613 Date Completed: 20240613 Latest Revision: 20240617 |
| رمز التحديث: | 20240617 |
| DOI: | 10.1212/WNL.0000000000209495 |
| PMID: | 38870442 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1526-632X |
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| DOI: | 10.1212/WNL.0000000000209495 |