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Age is negatively associated with upper limb recovery after conventional but not robotic rehabilitation in patients with stroke: a secondary analysis of a randomized-controlled trial

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Abstract

Background

There is consistent evidence that robotic rehabilitation is at least as effective as conventional physiotherapy for upper extremity (UE) recovery after stroke, suggesting to focus research on which subgroups of patients may better respond to either intervention. In this study, we evaluated which baseline variables are associated with the response after the two approaches.

Methods

This is a secondary analysis of a randomized-controlled trial comparing robotic and conventional treatment for the UE. After the assigned intervention, changes of the Fugl-Meyer Assessment UE score by ≥ 5 points classified patients as responders to treatment. Variables associated with the response were identified in a univariate analysis. Then, variables independently associated with recovery were investigated, in the whole group, and the two groups separately.

Results

A sample of 190 patients was evaluated after the treatment; 121 were responders. Age, baseline impairment, and neglect were significantly associated with worse response to the treatment. Age was the only independently associated variable (OR 0.967, p = 0.023). Considering separately the two interventions, age remained negatively associated with recovery (OR 0.948, p = 0.013) in the conventional group, while none of the variables previously identified were significantly associated with the response to treatment in the robotic group.

Conclusions

We found that, in our sample, age is significantly associated with the outcome after conventional but not robotic UE rehabilitation. Possible explanations may include an enhanced positive attitude of the older patients towards technological training and reduced age-associated fatigue provided by robotic-assisted exercise. The possibly higher challenge proposed by robotic training, unbiased by the negative stereotypes concerning very old patients’ expectations and chances to recover, may also explain our findings.

Trial registration number

NCT02879279.

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Data availability

The authors are available to send data to those who reasonably request it.

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Acknowledgements

Fondazione Don Gnocchi Robotic Rehabilitation Group members: Roma (RM): Irene Aprile, Marco Germanotta, Arianna Cruciani, Simona Loreti, Stefania Lattanzi, Laura Cortellini, Dionysia Papadopoulou, Giuliana Liberti, Francesca Panzera, Piera Mitrione, Dario Ruzzi, Giuliana Rinaldi, Camilla Galli, Sabina Insalaco, Luca Padua, Fabio De Santis, Pietro Spinelli, Serena Marsan, Ilaria Bastoni, Annarita Pellegrino, Tommasangelo Petitti, Costanza Pazzaglia, Chiara Di Blasi. Milano (MI): Angelo Montesano, Anna Castagna, Cristina Grosso, Paola Ammenti, Davide Cattaneo, Luca Azzinnaro, Daniela Barbieri, Silvia Cassani, Chiara Corrini, Matteo Meotti, Riccardo Parelli, Albino Spedicato, Marta Zocchi, Marcella Loffi, Domitilla Manenti, Laura Negri, Furio Gramatica, Valerio Gower. Rovato (BS): Silvia Galeri, Fulvia Noro, Luca Medici, Romina Garattini, Federica Bariselli, Marin Luli, Vera Rota. La Spezia (SP): Manuela Diverio, Elena Giannini, Assunta Gabrielli, Barbara Deidda, Benedetta Gnetti, Paola Beatini, Giulia Giansanti, Angela Lograsso, Stefania Callegari. Firenze (FI): Francesco Converti, Assunta Pizzi, Catuscia Falsini, Antonella Romanelli, Gabriella De Luca, Federica Vannetti, Elisabetta Simoncini, Monica Martini, Elisa Peccini. Massa e Fivizzano (MS): Francesca Cecchi, Lucia Avila, Maria Assunta Gabrielli, Manuele Barilli, Emanuela Romano, Elisabetta Bertocchi, Giorgia Giannarelli, Elisabetta Lerda, Miriam Vasoli, Paolo Rossi, Valter Marsili, Brunella Tognoli, Andrea Bertolini. Sant’Angelo dei Lombardi (AV): Giovanni Vastola, Gabriele Speranza, Massimo Colella, Rita Mosca, Gaetanina Competiello, Antonietta Chiusano, Antonella Della Vecchia, Pasqualina Soriano, Michela Pagliarulo. Acerenza (PZ), Tricarico (MT): Vito Remollino, Emanuele Langone, Marcello Magliulo, Giuseppe Araneo, Lucia Galantucci, Nicola Lioi, Federico Marrazzo, Stefano Larocca, Roberta Calia, Sara Benevento, Olga Toscano, and Michele Lategana.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269, 50143, Florence, Italy

    Francesca Cecchi, Marco Germanotta, Claudio Macchi, Manuela Diverio, Catiuscia Falsini, Monica Martini, Rita Mosca, Emanuele Langone, Dionysia Papadopoulou & Irene Aprile

  2. Department of Experimental and Clinical Medicine, Università Di Firenze, Largo Brambilla 3, 50100, Florence, Italy

    Francesca Cecchi & Claudio Macchi

  3. IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy

    Angelo Montesano, Silvia Galeri & Maria Chiara Carrozza

  4. The Biorobotics Institute, Scuola Superiore Sant’Anna, Viale Rinaldo Piaggio, 34, Pontedera, 56025, Pisa, Italy

    Maria Chiara Carrozza

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  1. Francesca Cecchi
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  2. Marco Germanotta
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Corresponding author

Correspondence to Marco Germanotta.

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The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

Ethics approval

Experiments were conducted with approval from the Ethics Committee of IRCCS Don Gnocchi (FDG_6.4.2016 Prot. N.8/2016CE_FDG/FC/SA).

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All subjects gave informed written consent in accordance with the Declaration of Helsinki.

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Cecchi, F., Germanotta, M., Macchi, C. et al. Age is negatively associated with upper limb recovery after conventional but not robotic rehabilitation in patients with stroke: a secondary analysis of a randomized-controlled trial. J Neurol 268, 474–483 (2021). https://doi.org/10.1007/s00415-020-10143-8

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