Quick Take: Robot assisted training for the upper limb after stroke (RATULS)

Upper limb functionality is often compromised after a stroke, leading to distressing long-term consequences and a diminished quality of life. Therefore, optimizing upper limb recovery in these patients is imperative. A 2018 Cochrane review reported that robot-assisted arm training (RT) improved upper arm function, but the clinical significance of this result remains unclear due to study heterogeneity and variation in quality of the included studies. In this randomized, multicenter, controlled trial, 770 patients with moderate or severe upper limb functional limitation between one week and five years after their first stroke were assigned to receive either robot-assisted arm training, an enhanced upper limb therapy program (EULT), or usual care to study the impact on upper limb function success, defined using the Action Research Arm Test (ARAT), at 3 months. Robot-assisted training and EULT were provided for 45 min, three times per week for 12 weeks. The RT program integrated training with all three modules of the MIT-Manus robotic gym (shoulder-elbow module, wrist module, hand module integrated on to the shoulder-elbow module). The EULT program primarily consisted of repetitive functional task practice. Researchers found that at three months, there was no significant difference in upper limb functional recovery between RT and EULT (OR 0.78, 98.3% CI 0.48 to 1.27), nor between RT and usual care (OR 1.17, 98.3% CI 0.70 to 1.96). Similarly, there was no significant difference between EULT and usual care (OR 1.51, 98.3% CI 0.90 to 2.51). There were more adverse events in the RT group and the EULT group than in the usual care group, but none of these were related to a trial intervention. Overall, this study does not support the use of a robot-assisted training program using the MIT-Manus robotic gym for patients with upper limb functional limitations after stroke.

Click to read the study in Lancet

Image: PD

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