Poststroke robot-assisted training disappoints for improving upper limb function

  • Rodgers H & al.
  • Lancet
  • 21 May 2019

  • International Clinical Digest
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Takeaway

  • Among patients having upper limb functional limitation after stroke, robot-assisted training was not superior to either enhanced upper limb therapy or usual care for improving function.

Why this matters

Key results

  • 3-month rate of upper limb function success:
    • 42% with usual care,
    • 44% with robot-assisted training, and
    • 50% with enhanced upper limb therapy.
  • Vs usual care, no significant benefit of:
    • Robot-assisted training (aOR, 1.17; 98.3% CI, 0.70-1.96).
    • Enhanced upper limb therapy (aOR, 1.51; 98.3% CI, 0.90-2.51).
  • Rate of serious adverse events:
    • 8% with usual care,
    • 15% with robot-assisted training (P=.013), and
    • 13% with enhanced upper limb therapy (P=.08).
  • However, none attributable to interventions.

Study design

  • UK multicenter randomized controlled trial: 770 adults with stroke having moderate or severe upper limb functional limitation (RATULS trial).
  • Randomization:
    • Robot-assisted training (MIT-Manus robotic gym; 45 minutes, 3 times weekly, 12 weeks),
    • Enhanced upper limb therapy program (repetitive functional task practice; 45 minutes, 3 times weekly, 12 weeks), and
    • Usual care.
  • Main outcome: 3-month upper limb function success (Action Research Arm Test).
  • Funding: National Institute for Health Research.

Limitations

  • Outcome tool used needs further validation
  • Higher dropout is usual care group.
  • Usual care likely varied.

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