Effectiveness of robot-assisted arm therapy in stroke rehabilitation: An overview of systematic reviews

Issue title: Thematic Issue: Integrating Robot-assisted Therapy Into Neurorehabilitation Clinical Practice: Where Are We Now? Where Are We Heading?

Guest editors: Giovanni Morone, Robert Riener and Stefano Mazzoleni

Article type: Review Article

Authors: Straudi, Sofia^a | Baluardo, Ludovica^a | Arienti, Chiara^{b; *} | Bozzolan, Michela^c | Lazzarini, Stefano G.^b | Agostini, Michela^d | Aprile, Irene^e | Paci, Matteo^f | Casanova, Emanuela^g | Marino, Dario^h | La Rosa, Giuseppeⁱ | Bressi, Federica^j | Sterzi, Silvia^j | Giansanti, Daniele^k | Perrero, Luca^l | Battistini, Alberto^g | Miccinilli, Sandra^j | Filoni, Serena^m | Sicari, Monicaⁿ | Petrozzino, Salvatoreⁿ | Solaro, Claudio Marcello^o | Gargano, Stefano^p | Benanti, Paolo^q | Boldrini, Paolo^r | Bonaiuti, Donatella^s | Castelli, Enrico^t | Draicchio, Francesco^u | Falabella, Vincenzo^v | Galeri, Silvia^b | Gimigliano, Francesca^w | Grigioni, Mauro^k | Mazzoleni, Stefano^x | Mazzon, Stefano^y | Molteni, Franco^z | Petrarca, Maurizio^aa | Picelli, Alessandro^bb | Posteraro, Federico^cc | Senatore, Michele^dd | Turchetti, Giuseppe^ee | Morone, Giovanni^ff | Working group upper limb “CICERONE” Italian Consensus Conference on Robotic in Neurorehabilitation^{1; 2}

Affiliations: [a] Department of Neuroscience and Rehabilitation, Ferrara University, Ferrara, Italy | [b] IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy | [c] Interdepartmental Educational Service, Azienda Ospedaliero Universitaria S. Anna Ferrara, Ferrara, Italy | [d] San Camillo IRCCS, Venice, Italy | [e] IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy | [f] AUSL (Unique Sanitary Local Company) District of Central Tuscany, Florence, Italy | [g] IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy | [h] IRCCS Neurolysis Center “Bonino Pulejo”, Messina, Italy | [i] Consorzio Siciliano di Riabilitazione (CSR), Catania, Italy | [j] Campus Bio-Medico University Hospital Foundation, Rome, Italy | [k] National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy | [l] Neurorehabilitation Unit, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy | [m] Padre Pio Onlus Rehabilitation Centers Foundation, San Giovanni Rotondo, Italy | [n] A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy | [o] CRRF “Mons. Luigi Novarese”, Vercelli, Italy | [p] IRCCS Fondazione Don Carlo Gnocchi, Turin, Italy | [q] Pontifical Gregorian University, Rome, Italy | [r] Società Italiana di Medicina Fisica e Riabilitativa (SIMFER), Rome, Italy | [s] Istituto Geriatrico Piero Redaelli, Milan, Italy | [t] Department of Paediatric Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital,, Rome, Italy | [u] Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy | [v] Italian Federation of Persons with Spinal Cord Injuries (Faip Onlus), Rome, Italy | [w] Department of Mental, Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy | [x] Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy | [y] AULSS6 (Unique Sanitary Local Company), Euganea Padova - Distretto 4 “Alta Padovana”, Padua, Italy | [z] Department of Rehabilitation Medicine, Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy | [aa] Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children’s Hospital, Rome, Italy | [bb] Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy | [cc] Department of Rehabilitation, Versilia Hospital – AUSL12, Viareggio, Italy | [dd] Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy | [ee] Management Institute, Sant’Anna School of Advanced Studies, Pisa, Italy | [ff] Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy | [gg] Multidisciplinary Department of Medicine for Surgery and Orthodontics, University of Campania “Luigi Vanvitelli”, Naples, Italy | [hh] IRCCS Santa Lucia Foundation, Rome, Italy | [ii] Department of Neuroscience, IRCCS San Raffaele Pisana, Rome, Italy | [jj] Università degli Studi di Torino, Turin, Italy

Correspondence: [*] Address for correspondence: Chiara Arienti, PhD, Cochrane Rehabilitation, IRCSS Fondazione Don Carlo Gnocchi, Milan, Italy. E-mail: carienti@dongnocchi.it.

Note: [1] Working group upper limb “CICERONE” Italian Consensus Conference on Robotic in Neurorehabilitation: Michela Agostini; Irene Aprile; Ludovica Baluardo; Alberto Battistini; Paolo Benanti; Valentina Boetto; Paolo Boldrini; Donatella Bonaiuti; Marco Bravi; Federica Bressi; Diletta Bruno; Emanuela Casanova; Enrico Castelli; Manuela Desilvestri; Francesco Draicchio; Vincenzo Falabella; Serena Filoni; Silvia Galeri; Marialuisa Gandolfi; Stefano Gargano; Daniele Giansanti; Francesca Gimigliano; Mauro Grigioni; Giuseppe La Rosa; Dario Marino; Alex Martino Cinnera; Stefano Mazzoleni; Stefano Mazzon; Sandra Miccinilli; Franco Molteni; Giovanni Morone; Matteo Paci; Angela Palomba; Cristiano Pecchioli; Luca Perrero; Maurizio Petrarca; Salvatore Petrozzino; Alessandro Picelli; Federico Posteraro; Emanuele Francesco Russo; Fabio Santacaterina; Michele Senatore; Monica Sicari; Claudio Marcello Solaro; Silvia Sterzi; Sofia Straudi; Giuseppe Turchetti.

Note: [2] Collaborators: Angela Palombagg, Alex Martino Cinnerahh, Manuela Desilvestril, Marco Bravij, Diletta Brunoj, Fabio Santacaterinaj, Cristiano Pecchioliii, Gandolfi Marialuisabb, Emanuele Francesco Russom, Valentina Boettojj.

Abstract: BACKGROUND:Robot-assisted arm therapy (RAT) has been used mainly in stroke rehabilitation in the last 20 years with rising expectations and growing evidence summarized in systematic reviews (SRs). OBJECTIVE:The aim of this study is to provide an overview of SRs about the effectiveness, within the ICF domains, and safety of RAT in the rehabilitation of adult with stroke compared to other treatments. METHODS:The search strategy was conducted using search strings adapted explicitly for each database. A screening base on title and abstract was realized to find all the potentially relevant studies. The methodological quality of the included SRs was assessed using AMSTAR-2. A pre-determined standardized form was used to realize the data extraction. RESULTS:18 SRs were included in this overview. Generally, positive effects from the RAT were found for motor function and muscle strength, whereas there is no agreement for muscle tone effects. No effect was found for pain, and only a SR reported the positive impact of RAT in daily living activity. CONCLUSION:RAT can be considered a valuable option to increase motor function and muscle strength after stroke. However, the poor quality of most of the included SRs could limit the certainty around the results.

Keywords: Stroke, arm rehabilitation, robot-assisted arm therapy, end-effector devices, exoskeleton devices

DOI: 10.3233/NRE-220027

Journal: NeuroRehabilitation, vol. 51, no. 4, pp. 559-576, 2022