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

BACKGROUND Electromechanical and robot-assisted arm training devices are used in rehabilitation and might 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 and arm function and motor strength of patients after stroke, and the acceptability and safety of the therapy. SEARCH STRATEGY We searched the Cochrane Stroke Group Trials Register (last searched October 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2007), MEDLINE (1950 to October 2007), EMBASE (1980 to October 2007), CINAHL (1982 to October 2007), AMED (1985 to October 2007), SPORTDiscus (1949 to October 2007), PEDro (searched October 2007), COMPENDEX (1972 to October 2007) and INSPEC (1969 to October 2007). We also handsearched relevant conference proceedings, searched trials and research registers, checked reference lists, and contacted trialists, experts and researchers in our field, and manufacturers of commercial devices. SELECTION CRITERIA Randomised controlled trials comparing electromechanical and robot-assisted arm training for recovery of arm function with other rehabilitation interventions or no treatment for patients after stroke. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, assessed trial quality and extracted data. We contacted trialists for additional information. We analysed the results as standardised mean differences (SMDs) for continuous variables and relative risk differences (RD) for dichotomous variables. MAIN RESULTS We included 11 trials (328 participants) in this review. Electromechanical and robot-assisted arm training did not improve activities of daily living (SMD = 0.29; 95% confidence interval (CI) -0.47 to 1.06; P = 0.45; I(2 )= 85%). Arm motor function and arm motor strength improved (SMD = 0.68, 95% CI 0.24 to 1.11; P = 0.002; I(2 )= 56% and SMD = 01.03, 95% CI 0.29 to 1.78; P = 0.007; I(2 )= 79% respectively). Electromechanical and robot-assisted arm training did not increase the risk of patients to drop out (RD) (fixed-effect model) = 0.01; 95% CI -0.05 to 0.06; P = 0.77; I(2 )= 0.0%) and adverse events were rare. AUTHORS' CONCLUSIONS Patients who receive electromechanical and robot-assisted arm training after stroke are not more likely to improve their activities of daily living, but arm motor function and strength of the paretic arm may improve. However, the results must be interpreted with caution because there were variations between the trials in the duration, amount of training and type of treatment, and in the patient characteristics.