Effects of Combining Robotic Assisted Therapy for Upper Limb With Other Therapeutic Approaches After Stroke: A Systematic Review and Meta-Analysis of Randomized Control Trials.

BACKGROUND AND PURPOSE: Robotic-assisted therapy for the upper limb (RAT-UL) is a well-established, evidence-based approach to stroke rehabilitation. However, the effectiveness of combining RAT-UL with other therapeutic approaches remains unclear. This systematic review and meta-analysis, registered in PROSPERO (CRD42023422583), aimed to investigate the effect of combination therapy added to RAT-UL compared with RAT-UL alone on improving the motor function, and capacity of the affected upper limb and activity of daily living.

METHODS

A systematic search was conducted in PubMed, CINAHL, Physiotherapy Evidence Database (PEDro), and Web of Science. We included randomized controlled trials (RCTs) published in English before October 2024. Methodological quality was assessed using the Cochrane risk of bias tool for RCTs. Meta-analysis was performed using RevMan 5.4 software. The primary inclusion criteria encompassed adults after stroke who underwent combining RAT-UL with other therapeutic approaches.

RESULTS

After reviewing 5669 studies, we included 16 RCTs in this study. The overall effect of combining RAT-UL with other therapeutic approaches on the motor function in Fugl-Meyer Assessment was not significant improvement (MD = 1.40; 95% CI, 0.00-2.81; p = 0.05), whereas the differences on capacity of upper limb in Wolf Motor Function Test-Performance Time (MD = 0.48; 95% CI, 0.01-0.94; p = 0.04) and activities of daily living in the Functional Independence Measure were also observed (MD = 2.21; 95% CI, 0.12-4.31; p = 0.04). However, no significant differences were found in the analysis of activity levels in the ICF domains (SMD = 0.50; 95% CI, -1.33-2.34; p = 0.08). Subgroup analyses showed significant improvements in motor function in the Fugl-Meyer Assessment when partial substitution of RAT-UL with other high-intensity therapeutic approaches (MD = 3.42; 95% CI, 0.61-6.24; p = 0.02).

DISCUSSION: Adding a high-intensity therapeutic approach to RAT-UL may lead to improvement in upper limb function and capacity compared with RAT-UL alone. However, the effectiveness of combining RAT-UL with other therapeutic approaches appears to vary depending on the type of adjunctive therapy employed. The effect sizes were small, and the findings across studies were inconsistent.

TRIAL REGISTRATION: PROSPERO (CRD42023422583).