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Robot-assisted distal training improves upper limb dexterity and function after stroke: a systematic review and meta-regression

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Abstract

Introduction

Stroke is one of the top 10 causes of death worldwide, and more than half of stroke patients face distal upper extremity dysfunction. Considering that robot-assisted training may be effective in improving distal upper extremity function, the review evaluated the effect of robot-assisted distal training on motor function, hand dexterity, and spasticity after stroke.

Methods

Eleven databases were systematically searched for randomised controlled trials (RCTs) from inception until Aug 28, 2021. Meta-analysis and meta-regression were performed to investigate the overall effect and source of heterogeneity, respectively.

Results

Twenty-two trials involving 758 participants were included in this systematic review. The overall effect of robot-assisted distal training on the motor function of the wrists and hands was significant improvement (MD = 3.92; 95% CI, 3.04–4.80; P < 0.001). The robot-assisted training had a significantly beneficial effect on other motor functions (MD = 2.84; 95% CI, 1.54–4.14; P < 0.001); dexterity (MD = 9.01; 95% CI, -12.07–-5.95; P < 0.001), spasticity, upper extremity strength (SMD = 0.42; 95% CI, 0.07–0.78; P = 0.02) and activities of daily living (SMD = 0.70; 95% CI, 0.29–1.23; P < 0.001). A series of subgroup analyses showed preferable design and effective regime of training. Meta-regression indicated the statistically significant effect of the year of trial, country, and duration on the effectiveness of training.

Conclusion

Robot-assisted distal training has a significant effect on motor function, dexterity and spasticity of the upper extremity, compared to conventional therapy.

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Acknowledgements

We would like to thank authors for sending further information on their studies for the purpose of our systematic review.

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Authors and Affiliations

  1. The Affiliated Hospital of Qingdao University, Shandong, Qingdao, China

    Menglu Zhao

  2. Qingdao Municipal Hospital, Qingdao, Shandong, China

    Guangning Wang

  3. School of Nursing, Qingdao University, Qingdao, Shandong, China

    Aimin Wang

  4. Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore

    Ling Jie Cheng

  5. Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore

    Ying Lau

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Contributions

MLZ and was involved in generating search strategies and performing the literature search, screening articles, extracting and analysing data, and writing the manuscript. YL was involved in developing the research question, planning the search, guiding the article screening and selection process, providing help in the interpretation of data and revising the manuscript. GNW was involved in the article screening and selection process. AW was involved in the article investigation. LJC was involved in the article investigation, performing the literature search, providing help in the interpretation of data and revising the manuscript, reference editing and revising and formatting of the manuscript. All authors approved of the last version of manuscript.

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Correspondence to Ying Lau.

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Zhao, M., Wang, G., Wang, A. et al. Robot-assisted distal training improves upper limb dexterity and function after stroke: a systematic review and meta-regression. Neurol Sci 43, 1641–1657 (2022). https://doi.org/10.1007/s10072-022-05913-3

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