The sustainability of upper limb robotic therapy for stroke survivors in an inpatient rehabilitation setting

Abstract

Purpose

To investigate the sustainability of Robot-assisted upper limb therapy (RT-UL) as part of routine occupational therapy and physiotherapy clinical practice.

Methods

Two separate audits, 12 months apart, of RT-UL computer data records were undertaken to determine sustainability in a subacute rehabilitation unit. Records of the two audits were compared in terms of the number of early subacute stroke survivors using RT-UL, the number of RT-UL sessions, duration of RT-UL sessions, and disciplines prescribing RT-UL.

Results

During Audit 1 58% (n = 18) of stroke survivors received RT-UL compared to 50% (n = 7) in Audit 2. The total number of RT-UL sessions reduced between audits (148 vs. 36 sessions) reflecting the overall reduction in admission rates for stroke survivors. There was no significant difference between audits in the average number of RT-UL sessions per patient (p = 0.203) nor the length of sessions (p = 0.762). Patients engaged in active therapy more than three-quarters of the time when on the robotic device. Physiotherapists were the primary prescribers of RT-UL when compared to occupational therapists.

Conclusions

RT-UL was in continued and regular use with stroke survivors 2 years after initial implementation within an inpatient rehabilitation setting. RT-UL practice was intensive and used routinely with patients.

IMPLICATIONS FOR REHABILITATION

• RT-UL is a sustainable and intensive intervention for stroke survivors within an inpatient rehabilitative setting.

• The cost-benefits of RT-UL should be evaluated from the perspective of the whole rehabilitation service not just at an individual patient level.

• RT-UL may be considered a “bridging” form of UL practice for those with more limited active UL movement until there is sufficient UL movement and power for more complex real-world task-specific practice.

Keywords:

• Robotics
• stroke rehabilitation
• upper extremity
• occupational therapy
• physical therapy
• implementation

Ethical approval

Ethical approval for the study was gained from The Prince Charles Hospital Human Research Ethics Committee (HREC) (HREC/16/QPCH/36) and the Australian Catholic University HREC (2016-266R). The research programme was approved as low risk and a waiver of consent was granted for the audits.

Disclosure statement

All authors declare that there were no conflicts of interest in this study.

Health and safety

All mandatory health and safety procedures have been complied with in the course of conducting any experimental work reported in this paper.

Additional information

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.