The Combined Effect of Robot-assisted Therapy and Activities of Daily Living Training on Upper Limb Recovery in Persons With Subacute Stroke: A Randomized Controlled Trial

Abstract

Objectives

To evaluate the effectiveness of robot-assisted therapy (RAT) followed by activities of daily living (ADL) training in comparison with conventional rehabilitation therapy (CRT) and ADL training in individuals with subacute stroke.

Design

A single-blind, two-arm, parallel-group, open-level, randomized controlled trial.

Setting

A tertiary care teaching hospital in India

Participants

Forty-four persons (n=44) with first-ever stroke (in subacute stage) were enrolled from August 2021, to July, 2023.

Intervention

Participants in the RAT group (n=22) received RAT for 30 minutes, followed by ADL training for 30 minutes. In contrast, participants in the CRT group (n=22) received CRT (30 minutes) followed by ADL training (30 minutes). Both groups received allocated interventions for 15 days over 3 weeks (5-days/week, 3 weeks).

Main Outcome Measures

Primary outcome: Motor domain score of the Fugl-Meyer Assessment scale for upper extremity (FMA-UE). Secondary outcomes: the other domains scores of FMA-UE (UL -sensation, -joint motions, -joint pain); Modified Ashworth Scale (MAS) (spasticity); hand-function (HF) and ADL-domain scores of the stroke impact scale (SIS); WHOQQL-BREF questionnaires (QOL). Participants were assessed at enrolment and follow-up at 3, 6, and 12 weeks.

Results

Persons who received RAT and ADL training reported significant improvement (p<0.05) in UL motor function [Mean difference (MD)=3.54;(95% confidence interval (CI): 1.28 to 5.79)], UL passive joint motions [MD=2.54; (95%CI: 1.56 to 3.52)], SIS-HF [MD=6.37;(95% CI: 4.75 to 7.99)], SIS-ADL [MD=7.13(95%CI: 3.52 to 8.74)], and in all domains of WHOQOL-BREF (except environmental domain) compared to persons who received CRT and ADL training at 12 weeks.

Conclusions

The findings indicate that RAT followed by ADL training is more effective than CRT followed by ADL training in motor improvement, hand functions, ADL, and QOL at 12 weeks.