Portable robots for upper-limb rehabilitation after stroke: a systematic review and meta-analysis

Figures & data

Table 1. PEDro scale [23].

1. Eligibility criteria were specified	☐no	☐yes	☐where
2. Subjects were randomly allocated to groups (in a crossover study, subjects were randomly allocated an order in which treatments were received)	☐no	☐yes	☐where
3. Allocation was concealed	☐no	☐yes	☐where
4. The groups were similar at baseline regarding the most important prognostic indicators	☐no	☐yes	☐where
5. There was blinding of all subjects	☐no	☐yes	☐where
6. There was blinding of all therapists who administered the therapy	☐no	☐yes	☐where
7. There was blinding of all assessors who measured at least one key outcome	☐no	☐yes	☐where
8. Measures of at least one key outcome were obtained from more than 85% of the subjects initially allocated to groups	☐no	☐yes	☐where
9. All subjects for whom outcome measures were available received the treatment or control condition as allocated or, where this was not the case, data for at least one key outcome was analysed by ‘intention to treat’	☐no	☐yes	☐where
10. The results of between-group statistical comparisons are reported for at least one key outcome	☐no	☐yes	☐where
11. The study provides both point measures and measures of variability for at least one key outcome	☐no	☐yes	☐where

Figure 1. Information selection flow diagram of different phases.

Table 2. PEDro Scores of included studies.

Study	2	3	4	5	6	7	8	9	10	11	Score
Hsieh et al. [25]	1	1	1	0	0	1	1	1	1	1	8
Liao et al. [26]	1	1	1	0	0	1	1	1	1	1	8
Wu et al. [27]	1	1	1	1	1	1	1	1	1	1	10
Wolf et al. [28]	1	1	1	0	0	0	1	0	1	1	6
Qian et al. [29]	1	0	1	0	0	0	1	1	1	1	6
Villafañe et al. [14]	1	1	1	1	1	1	1	1	1	1	10
Budhota et al. [30]	1	1	1	1	1	1	1	1	1	1	10
Guo et al. [31]	1	0	1	1	0	1	1	1	1	1	8
Coskunsu et al. [32]	1	1	1	1	0	1	1	1	1	1	9

Table 3. Basic information about included studies.

Study	Interventions EG vs CG	Participations	Age(years) mean ± SD or median (IQR)	Months after stroke Mean ± SD or Median (IQR)	Place	Intervention time setting			Measuring instrument	Results
						Session duration (minutes)	Frequency (weeks)	Duration (weeks)
Hsieh et al. [25]	RT + CT vs CT	EG: 6 CG: 6	EG: 56.04 ± 13.74 CG: 54.00 ± 8.05	EG: 21.33 ± 7.17 CG: ±	Hospital	90	5	4	FMA, MMSE, MAS, MRC	Most patients showed improvements in primary outcomes after the interventions.
Liao et al. [26]	RT + CT vs CT	EG: 10 CG:10	EG: 55.51 ± 11.17 CG: 54.56 ± 8.20	EG: 23.90 ± 13.39 CG: 22.20 ± 17.47	Hospital	90	5	4	FMA, FIM, MAL, ABILHAND	A significant difference was found between the two groups for the primary outcome measure.
Wu et al. [27]	RT + CT vs CT	EG: 14 CG: 14	EG: 55.13 ± 12.72 CG: 51.30 ± 6.23	EG: 18.00 ± 8.65 CG: 17.57 ± 9.80	Hospital	90	5	4	FMA, MAL, SIS, ADL	Large and significant effects were found in the kinematic variables, distal part of upper-limb motor impairment, and specific aspects of quality of life in favour of RT. RT may improve shoulder flexion and quality of life.
Wolf et al. [28]	RT + CT vs CT	EG: 47 CG: 45	EG: 59.1 ± 14.1 CG: 54.7 ± 12.2	EG: 3.85 ± 1.77 CG: 4.23 ± 1.54	Home	180	5	8	ARAT, WMFT, FMA	Both groups demonstrated improvement across all UE outcomes.
Qian et al. [29]	RT + CT vs CT	EG: 14 CG: 10	EG: 54.6 ± 11.3 CG: 64.6 ± 3.43	EG: 25-148 CG: 14-142	Hospital	40	5	4	FMA, ARAT, FIM, MAS	This study indicated that in the early stage after stroke, motor function in the paretic upper limbs of stroke participants could be significantly improved through traditional rehabilitation treatment and upper limb training by the NMES-robotic system.
Villafañe et al. [14]	RT + CT vs CT	EG: 16 CG: 16	EG: 67 ± 11 CG: 70 ± 12	EG: No-Data CG: No-Data	Hospital	90	3	3	NHSS, MAS, BI, MI, QuickDASH, VAS	The experimental group had a more significant reduction in pain compared with the control group at the end of the intervention.
Budhota et al. [30]	RT + CT vs CT	EG: 22 CG: 22	EG: 56.32 ± 10.37 CG: 54.59 ± 10.92	EG: 15.27 ± 15.04 CG: 13 ± 10.92	Hospital	90	3	6	FMA, ARAT, GS	Time-matched combinatory training incorporating H-Man RAT produced similar outcomes to conventional therapy alone.
Guo et al. [31]	RT + CT vs CT	EG: 10 CG: 10	EG: 56.9 ± 6.1 CG: 53.5 ± 8.3	EG: 11.7 ± 5.4 CG: 10.9 ± 7.9	Hospital	60	5	2	FMA-UL, WMFT, MAS	The upper limb function improved significantly in the experimental group
Coskunsu et al. [32]	RT + CT vs CT	EG: 11 CG: 12	EG: 59.9 ± 14.2 CG: 70.0 ± 14.0	EG: No-Data CG: No-Data	Hospital	60	5	3	FMA, ARAT, MAL	This preliminary study observed improvements in motor functions, daily living activities, and force in both groups. However, incorporating EMG-driven robotic treatment into the neurophysiological rehabilitation program did not yield additional benefits to the clinical outcomes over three weeks in acute stroke patients.

Abbreviations: ABILHAND, An interview-based assessment of a patient-reported measure of the perceived difficulty in using their hand to perform manual activities in daily activities; ADL, activities of daily living; ARAT, action research arm test; CT, conventional therapy; FMA, Fugl-Meyer Assessment; FMA-UL, Fugl-Meyer Motor Assessment of Upper Limb; FIM, Functional Independence Measure; GS, grip strength.; MAL, Motor Activity Log; MAS, Modified Ashworth Scale; MMSE, mini-mental state examination; MRC, Medical Research Council; NIHSS, National Institutes of Health Stroke Scale; BI, Barthel Index; MI, Motricity Index; QuickDASH, short version of the Disabilities of the Arm, Shoulder and Hand; SIS, Stroke Impact Scale; MdAS, Modified Ashworth Scale.; WMFT, Wolf Motor Function Test.; RT, robot-assisted therapy; VAS, visual analogue scale.

Note: a. Continuous data are expressed as mean (standard deviation), and categoric data are expressed as a number; b. P values are associated with the χ2 test for categoric variables and 1-way analysis of variance for continuous variables.

Table 4. Information about the rehabilitation device.

Study	System name	DOF	Weight	Supported movements	Actuators	Type	Mode of wear/use
Hsieh et al. [25]	Bi-Manu-Track	1	46.4 kg	FA and WR	DC motor*2	End-effector based	The patient’s arm is secured within the groove of the rehabilitation machine, ensuring proper placement.
Liao et al. [26]	Bi-Manu-Track	1	46.4 kg	FA and WR	DC motor*2	End-effector based	The patient’s arm is secured within the groove of the rehabilitation machine, ensuring proper placement.
Wu et al. [27]	Bi-Manu-Track	1	46.4 kg	FA and WR	DC motor*2	End-effector based	The patient’s arm is secured within the groove of the rehabilitation machine, ensuring proper placement.
Wolf et al. [28]	Hand Mentor Pro	1	No Data	HD	McKibben air muscle	End-effector based	The device is designed to be worn on the patient’s hand and arm.
Qian et al. [29]	NMES-Robotic system	2	No Data	EL, FA and WR	Servo motor*2	Exoskeleton based	Wearable
Villafañe et al. [14]	Gloreha	6	No Data	HD	No Data	Orthosis	The device is designed to be worn on the patient’s hand and arm.
Budhota et al. [30]	H-man	2	15kg	SH, EL, FA and WR	No	End-effector based (Planar)	Wearable
Guo et al. [31]	Soft Robotic Glove	6	No Data	HD	Exclusive valve	Orthosis	The device is designed to be worn on the patient’s hand and arm.
Coskunsu et al. [32]	Hand of Hope	6	No Data	HD	motor	Exoskeleton based	The device is worn on the patient’s hand and arm

SH: shoulder, EL: elbow, FA: forearm, WR: wrist and HD: hand.

Figure 2. Forest plot of experimental group FMA: after vs before.

Figure 3. Egger’s test for publication bias plot.

Table 5. Egger’s test.

Std_E	Coef.	Std. Err.	t	P>|t|	[95% Conf. Interval]
Slope	−.9117794	.5764753	−1.58	0.165	−2.322364 .4988049
Bias	3.816237	1.579249	2.42	0.052	−.0480464 7.68052

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Data availability statement

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.