Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke

  • Conclusions changed
  • Review
  • Intervention

Authors

  • Jan Mehrholz,

    Corresponding author
    1. Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbH, Wissenschaftliches Institut, Kreischa, Germany
    2. SRH Fachhochschule für Gesundheit Gera gGmbH, Sektion Therapiewissenschaften, 07548 Gera, Germany
    3. Technical University Dresden, Department of Public Health, Dresden Medical School, Dresden, Germany
    • Jan Mehrholz, Wissenschaftliches Institut, Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbH, An der Wolfsschlucht 1-2, Kreischa, 01731, Germany. jan.mehrholz@klinik-bavaria.de.

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  • Marcus Pohl,

    1. Helios Klinik Schloss Pulsnitz, Neurological Rehabilitation, Pulsnitz, Saxony, Germany
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  • Thomas Platz,

    1. Ernst-Moritz-Arndt-Universität Greifswald, Neurorehabilitation Centre and Spinal Cord Injury Unit, BDH-Klinik Greifswald, Greifswald, Germany
    2. Ernst-Moritz-Arndt-Universität, Neurowissenschaften, Greifswald, Germany
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  • Joachim Kugler,

    1. Technical University Dresden, Department of Public Health, Dresden Medical School, Dresden, Germany
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  • Bernhard Elsner

    1. Faculty of Medicine Carl Gustav Carus, TU Dresden, Department of Public Health, Dresden, Sachsen, Germany
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Abstract

Background

Electromechanical and robot-assisted arm training devices are used in rehabilitation, and may help to improve arm function after stroke.

Objectives

To assess the effectiveness of electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength in people after stroke. We also assessed the acceptability and safety of the therapy.

Search methods

We searched the Cochrane Stroke Group's Trials Register (last searched February 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2015, Issue 3), MEDLINE (1950 to March 2015), EMBASE (1980 to March 2015), CINAHL (1982 to March 2015), AMED (1985 to March 2015), SPORTDiscus (1949 to March 2015), PEDro (searched April 2015), Compendex (1972 to March 2015), and Inspec (1969 to March 2015). We also handsearched relevant conference proceedings, searched trials and research registers, checked reference lists, and contacted trialists, experts, and researchers in our field, as well as manufacturers of commercial devices.

Selection criteria

Randomised controlled trials comparing electromechanical and robot-assisted arm training for recovery of arm function with other rehabilitation or placebo interventions, or no treatment, for people after stroke.

Data collection and analysis

Two review authors independently selected trials for inclusion, assessed trial quality and risk of bias, and extracted data. We contacted trialists for additional information. We analysed the results as standardised mean differences (SMDs) for continuous variables and risk differences (RDs) for dichotomous variables.

Main results

We included 34 trials (involving 1160 participants) in this update of our review. Electromechanical and robot-assisted arm training improved activities of daily living scores (SMD 0.37, 95% confidence interval (CI) 0.11 to 0.64, P = 0.005, I² = 62%), arm function (SMD 0.35, 95% CI 0.18 to 0.51, P < 0.0001, I² = 36%), and arm muscle strength (SMD 0.36, 95% CI 0.01 to 0.70, P = 0.04, I² = 72%), but the quality of the evidence was low to very low. Electromechanical and robot-assisted arm training did not increase the risk of participant drop-out (RD 0.00, 95% CI -0.02 to 0.03, P = 0.84, I² = 0%) with moderate-quality evidence, and adverse events were rare.

Authors' conclusions

People who receive electromechanical and robot-assisted arm and hand training after stroke might improve their activities of daily living, arm and hand function, and arm and hand muscle strength. However, the results must be interpreted with caution because the quality of the evidence was low to very low, and there were variations between the trials in the intensity, duration, and amount of training; type of treatment; and participant characteristics.

Plain language summary

Electromechanical-assisted training for improving arm function and disability after stroke

Review question

To assess the effects of electromechanical and robot-assisted arm and hand training for improving arm function in people who have had a stroke.

Background

More than two-thirds of people who have had a stroke have difficulties with reduced arm function, which can restrict a person's ability to perform everyday activities, reduce productivity, limit social activities, and lead to economic burden. Electromechanical and robot-assisted arm training uses specialised machines to assist rehabilitation in supporting shoulder, elbow, or hand movements. However, the role of electromechanical and robot-assisted arm training for improving arm function after stroke is unclear.

Study characteristics

We identified 34 trials (involving 1160 participants) up to March 2015 and included them in our review. Nineteen different electromechanical devices were described in the trials, which compared electromechanical and robot-assisted arm training with a variety of other interventions. Participants were between 21 to 80 years of age, the duration of the trials ranged from two to 12 weeks, the size of the trials was between eight and 127 participants, and the primary outcome differed between the included trials. Most of the trials were done in rehabilitation facilities in the USA.

Key results

Electromechanical and robot-assisted arm and hand training improved activities of daily living in people after stroke and function and muscle strength of the affected arm. As adverse events such as injuries and pain were seldom described, these devices can be applied as a rehabilitation tool, but we still do not know when or how often they should be used.

Quality of the evidence

The quality of the evidence was low to very low.

Laički sažetak

Vježbanje ruku pomoću elektromehaničkih uređaja i robota za poboljšanje funkcije ruku i onesposobljenosti nakon moždanog udara

Istraživačko pitanje

Cilj ovog Cochrane sustavnog pregleda literature bio je ispitati dokaze o djelovanju elektromehaničkih uređaja i robota na vježbanje ruke i šake za poboljšanje funkcije ruku u osoba koje su doživjele moždani udar.

Dosadašnje spoznaje

Više od dvije trećine osoba koje dožive moždani udar imaju problema sa smanjenom funkcijom ruke, što može otežavati obavljanje svakodnevnih aktivnosti, umanjiti produktivnost, ograničiti društvene aktivnosti te dovesti do ekonomskih posljedica. Vježbanje potpomognuto elektromehaničkim sredstvima i robotima koristi specijalizirane uređaje koji potpomažu rehabilitaciju tako što podržavaju pokrete ramena, lakta ili šake. Međutim, djelotvornost elektromehaničkih uređaja i robota u vježbanju ruke s ciljem poboljšanja funkcije ruke nakon uređaja nije poznata.

Obilježja istraživanja

U literaturi su pronađena 24 klinička pokusa (s ukupno 1160 ispitanika) objavljena do ožujka 2015. i uključena u ovaj sustavni pregled. U tim je studijama opisano 19 različitih elektromehaničkih uređaja, u kojima je uporaba različitih elektromehaničkih i robotski-potpomognutih vježbi za ruke uspoređena s nizom drugih intervencija. Ispitanici su imali od 21 do 80 godina, a studije su trajale od 2-12 tjedana, pri čemu je veličina studija bila od 8-127 ispitanika; glavni rezultati razlikovali su se među studijama. Većina je studija provedena u rehabilitacijskim centrima u SAD-u.

Ključni rezultati

Vježbanje ruke i šake pomoću elektromehaničkih uređaja i robota poboljšalo je obavljanje svakodnevnih aktivnosti u osoba koje su doživjele moždani udar, kao i funkciju i snagu mišića pogođene ruke. Nuspojave kao što su ozljede i bol rijetko su zabilježene; ti se uređaji mogu koristiti kao pomoć u rehabilitaciji, ali još uvijek nije poznato koliko često se trebaju koristiti.

Kvaliteta dokaza

Kvaliteta dokaza bila je niska do vrlo niska.

Bilješke prijevoda

Hrvatski Cochrane
Prevela: Livia Puljak
Ovaj sažetak preveden je u okviru volonterskog projekta prevođenja Cochrane sažetaka. Uključite se u projekt i pomozite nam u prevođenju brojnih preostalih Cochrane sažetaka koji su još uvijek dostupni samo na engleskom jeziku. Kontakt: cochrane_croatia@mefst.hr

Резюме на простом языке

Электромеханические тренировки для улучшения функции руки и снижения инвалидности после инсульта

Вопрос обзора

Оценить влияние электромеханических и роботизированных тренировок руки и кисти для улучшения функции руки у людей, перенесших инсульт.

Актуальность

Более чем две трети людей, перенесших инсульт, испытывают трудности, связанные со снижением функций руки, что может ограничить способность человека выполнять повседневные действия, снижает их производительность труда, ограничивает социальную активность, и становится экономическим бременем. При электромеханических и роботизированных тренировках руки используют специализированное оборудование, чтобы способствовать реабилитации в поддержании функции плеча, локтя, или движений в кистях рук. Однако, роль электромеханических и роботизированных тренировок для улучшения функции руки после инсульта остается неясной.

Характеристика исследований

Мы выявили 34 испытания (с участием 1160 человек) к марту 2015 года, и включили их в наш обзор. В испытаниях по сравнению электромеханических и роботизированных тренировок руки с различными другими вмешательствами были описаны 19 различных электромеханических устройств. Возраст участников варьировал от 21 до 80 лет, длительность испытаний - от 2 до 12 недель, размер испытаний - от 8 до 127 участников. Во включенных испытаниях первичные исходы существенно различались. Большинство испытаний были проведены в реабилитационных центрах США.

Основные результаты

Электромеханические и роботизированные тренировки руки и кисти улучшили повседневную активность у людей, перенесших инсульт, так же как и функции, и силу мышц пораженной руки. Так как неблагоприятные события, такие как травмы и боль, были редко описаны, эти устройства могут быть применены в качестве реабилитационного оборудования. Но мы до сих пор не знаем, когда и как часто их следует использовать.

Качество доказательств

Качество этих доказательств было низким и очень низким.

Заметки по переводу

Перевод: Зиганшина Лилия Евгеньевна. Редактирование: Юдина Екатерина Викторовна. Координация проекта по переводу на русский язык: Cochrane Russia - Кокрейн Россия (филиал Северного Кокрейновского Центра на базе Казанского федерального университета). По вопросам, связанным с этим переводом, пожалуйста, обращайтесь к нам по адресу: lezign@gmail.com

Laienverständliche Zusammenfassung

Elektromechanisch-unterstütztes Training zur Verbesserung von Armfunktion und Behinderung nach einem Schlaganfall

Reviewfrage

Wir untersuchten die Wirkung von elektromechanischem und roboterunterstütztem Arm- und Handtraining auf die Verbesserung der Armfunktion bei Menschen, die einen Schlaganfall erlitten haben.

Hintergrund

Mehr als zwei Drittel aller Menschen, die einen Schlaganfall erlitten haben, haben Schwierigkeiten mit einer eingeschränkten Armfunktion, was die Durchführung von Alltagsaktivitäten einschränken, die Leistungsfähigkeit verringern, soziale Aktivitäten beschränken und zu wirtschaftlichen Belastungen führen kann. Elektromechanisches und roboterunterstütztes Armtraining wird mit speziellen Geräten durchgeführt, um die Rehabilitation durch Unterstützung von Schulter-, Ellenbogen- oder Handbewegungen zu fördern. Die Rolle von elektromechanischem und roboterunterstütztem Training für die Verbesserung der Armfunktion nach einem Schlaganfall ist jedoch unklar.

Studienmerkmale

Bis März 2015 ermittelten wir 34 Studien (mit insgesamt 1160 Teilnehmern), die wir in unseren Review einschlossen. In den Studien wurden 19 verschiedene elektromechanische Geräte beschrieben, die ein elektromechanisches und roboterunterstütztes Armtraining mit einer Vielfalt anderer Behandlungsmaßnahmen verglichen. Die Teilnehmer waren zwischen 21 und 80 Jahren alt, die Studiendauer betrug zwei bis 12 Wochen, die Teilnehmerzahlen lagen zwischen acht und 127 und die Studien unterschieden sich hinsichtlich ihrer primären Endpunkte (vorrangigen Zielkriterien). Die meisten der Studien wurden in Rehabilitationseinrichtungen in den USA durchgeführt.

Hauptergebnisse

Elektromechanisches und roboterunterstütztes Arm- und Handtraining verbesserte die Durchführung von Alltagsaktivitäten sowie die Funktion und Muskelkraft des betroffenen Armes bei Menschen, die einen Schlaganfall erlitten hatten. Da Nebenwirkungen wie Verletzungen und Schmerzen selten erwähnt wurden können diese Geräte als Rehabilitationsmittel eingesetzt werden; wir wissen jedoch noch nicht, wann oder wie oft sie verwendet werden sollten.

Qualität der Evidenz

Die Qualität der Evidenz war niedrig bis sehr niedrig.

Anmerkungen zur Übersetzung

P. Heinrich, B. Elsner, Koordination durch Cochrane Schweiz