Introduction
Materials and methods
Search strategy and information sources
Eligibility criteria
Inclusion criteria
Exclusion criteria
Study selection
Critical appraisal of individual sources of evidence
Data charting process and data items
Ref | Country | Year | Study type | Study aim | Illness or accident leading to disability | Level of disability | Use of telerehabilitation | Use games and virtual reality |
---|---|---|---|---|---|---|---|---|
Hwang [66] | Republic of Korea | 2012 | Randomized controlled trials (RCT) | Evaluating robot-assisted hand and finger rehabilitation in stroke patients | Stroke | Fingers | √ | |
Carpinella [26] | Italy | 2012 | Pilot study | Comparing two reaching tasks (RT) and objects’ reaching and manipulation (RMT) protocols for upper extremity robot-based rehabilitation in MS patients | Multiple sclerosis (MS) | Upper limb | ||
Hu [56] | USA | 2013 | Experimental study | Investigating the effectiveness of robot-assisted upper limb training in stroke patients | Stroke | Fingers and wrist | √ | |
Squeri [57] | Italy | 2014 | Pilot study | Developing a novel therapeutic protocol aimed at restoring wrist functionality in chronic stroke patients | Stroke | Wrist and forearm | √ | |
Sale [76] | Italy | 2014 | RCT | Evaluating the effects of robot-assisted hand therapy compared to intensive occupational therapy in stroke patients | Stroke | Hand | ||
Sale [27] | Italy | 2014 | Before and after | Determining the short-term and long-term changes in the motor performance of patients with chronic hemiparesis after using a rehabilitation robot | Chronic hemiparesis | Upper limb | ||
Klamroth-Marganska [70] | Switzerland | 2014 | RCT | Evaluation of the effect of a skeleton robot in training the injured arm compared to conventional treatment | Stroke | Arm, elbow and shoulder | √ | |
Hsieh [58] | Taiwan | 2014 | Observational cohort study | Investigating the predictors of minimal clinically important changes on outcome measures after robot-assisted therapy | Stroke | Wrist and forearm | ||
Pennati [28] | Italy | 2015 | RCT | Investigating the effect of combining a short robotic exercise and chemical neurolysis in reducing spasm and improving function in patients with stroke | Stroke | Upper limb | ||
McCabe [29] | USA | 2015 | RCT | Investigating the effect of using robotics on motor learning of the upper limbs of chronic and injured stroke survivors | Stroke | Upper limb | ||
Chen [59] | China | 2015 | Not mentioned | Design and development of a cable wrist robotic rehabilitation device for motor training or assisting people with motor disabilities in the upper limb. | Stroke | Wrist and arm | √ | |
Vanmulken [71] | Netherlands | 2015 | Feasibility study | Investigating the feasibility of tactile robot technology in improving arm and hand performance and skill in people with cervical spinal cord injury | Spinal cord injury (C-SCI) | Arm and hand | ||
Gilliaux [30] | Belgium | 2015 | RCT | Evaluating the effectiveness of robot-assisted therapy in children with cerebral palsy | Cerebral Palsy | Upper limb | √ | |
Taveggia [31] | Italy | 2016 | RCT | Evaluating the effectiveness of robotic-assisted movement and activity in upper limb rehabilitation in hospitalized patients after stroke | Stroke | Upper limb | √ | |
Biggar [77] | United Kingdom | 2016 | Feasibility Study | Design and development of a wearable robotic glove to assist in the rehabilitation of patients at home | Stroke | Hand | ||
Orihuela-Espina [78] | Mexico | 2016 | RCT | Determining the effectiveness of robot-based treatments in the motor improvement of stroke patients | Stroke | Hand | ||
Song [32] | China | 2016 | Not mentioned | Development and design of a robot for upper limb telerehabilitation after a stroke | Stroke | Upper limb | √ | √ |
Vanoglio [79] | Italy | 2017 | RCT | Evaluating the feasibility and effectiveness of hand and arm rehabilitation with the help of a robot in subacute hemiplegic patients | Stroke | Hand | ||
Trujillo [33] | Italy | 2017 | Not mentioned | Assessing the relationship between quantitative electroencephalography (QEEG) measures and motor outcome in chronic stroke patients undergoing a robot-assisted rehabilitation program to predict motor recovery | Stroke | Upper limb | ||
Saita [34] | Japan | 2017 | Pilot study | Investigating the effects of robot-assisted rehabilitation and botulinum toxin in the treatment of paretic arm with spasticity in stroke patients | Stroke | Upper limb | ||
Nam [80] | Hong Kong | 2017 | RCT | Investigating the effects of robotic-assisted rehabilitation and training on the upper limbs of people with chronic stroke | Stroke | Hand and elbow | ||
McKenzie [60] | USA | 2017 | Cross sectional | Validation and evaluation of the effect of a rehabilitation robot in improving arm motor function after stroke | Stroke | Wrist and fingers | √ | |
Kim [72] | USA | 2017 | RCT | Comparison of long-term effects of external and internal focus after robot-assisted arm training | Stroke | Arm and shoulder | √ | |
Bishop [67] | Columbia | 2017 | Pilot Study | Investigating the effect of training with a robotic system on paralysis and hand function in hemiparesis patients | Hemiparesis | Fingers | √ | |
Housley [61] | USA | 2017 | Pilot study | Investigating the improvement of upper limb function and quality of life due to the use of a robot skeleton | Stroke | Wrist | √ | √ |
Hsieh [35] | Taiwan | 2017 | RCT | Investigating the therapeutic effects of robotic priming on daily function, movement disorders, and quality of life in stroke patients | Stroke | Upper limb | ||
Gandolfi [36] | Italy | 2018 | RCT | Comparison of the effect of robot-assisted hand training on muscle activity, hand skills, and upper limb dysfunction | MS | Upper limb | √ | |
Lee [74] | Korea | 2018 | Pilot study | Design, development and evaluation of a shoulder joint tracking module for upper limb rehabilitation robots | Stroke | Shoulders | ||
Germanotta [37] | Italy | 2018 | Cross-sectional | Evaluation of validity, capability and reliability of a robotic device for upper limb rehabilitation | Stroke | Upper limb | ||
Kim [38] | Korea | 2018 | Pilot stud | Evaluation of the effects of therapeutic exercise with a robot in improving the upper limb in patients with chronic stroke | Stroke | Upper limb | √ | |
Villafañe [68] | Italy | 2018 | RCT | Evaluation of the effect of robot and occupational therapy in motor improvement of stroke patients | Stroke | Fingers, shoulder, and arm | √ | |
Palermo [62] | Italy | 2018 | Before and after | Evaluation of the effects of robotic rehabilitation on ten subacute stroke survivors | Stroke | Shoulders, elbow, wrist | √ | |
Iwamoto [39] | Japan | 2018 | Not mentioned | Determining the effects of using single-joint hybrid auxiliary limb in upper limb rehabilitation of stroke patients | Stroke | Upper limb | ||
Kim [75] | South Korea | 2019 | RCT | Investigating the therapeutic effects of a shoulder robot on hemiplegic shoulder pain after stroke | Stroke | Shoulder | √ | |
Dehem [40] | Belgium | 2019 | RCT | Evaluating the effectiveness of upper limb robotic-assisted treatment as an alternative to conventional treatment in the rehabilitation of stroke patients | Stroke | Upper limb | √ | |
Hung [41] | Taiwan | 2019 | RCT | Investigating the effects of combined unilateral and bilateral hybrid therapy compared to robot-assisted therapy in patients with chronic stroke | Stroke | Upper Limb | ||
Conroy [42] | USA | 2019 | RCT | Investigating the effectiveness of robot therapy on motor outcomes of patients with moderate to severe arm disability with chronic stroke | Stroke | Upper limb | √ | |
Bonanno [43] | Italy | 2019 | Case series study | Investigating motor-functional improvement in multiple sclerosis patients after robot-assisted rehabilitation | MS | Upper limb | √ | |
Leem [44] | Republic of Korea | 2019 | Retrospective study | Determining the effect of robot therapy on stroke patients according to the demographic and clinical characteristics of these patients | Stroke | Upper limb | √ | |
Kim [45] | South Korea | 2019 | Before and after | Investigating the effect of sensory stimulation and upper limb function of stroke patients after rehabilitation with the help of robots and virtual reality | Stroke | Upper limb | √ | |
Tartamella [46] | Italy | 2020 | Case study | Evaluation of the usefulness of a robotic intensive neural rehabilitation program to improve functional independence in a 57-year-old patient with BRN | Brainstem radionecrosis (BRN) | Upper limb | √ | |
Solaro [47] | Italy | 2020 | RCT | Comparing robot-assisted training based on tactile or sensorimotor training in the rehabilitation of upper limb disabilities in multiple sclerosis patients | MS | Upper limb | √ | |
Picelli [63] | Italy | 2020 | RCT | Evaluation of the effects of robot-assisted arm therapy in patients with distal radius injury | Distal radius fracture | Wrist and forearm | ||
Kuo [69] | Taiwan | 2020 | Case series study | Investigating the effects of robot therapy in improving the upper limb disabilities of patients with cerebral palsy | Cerebral Palsy (CP) | Fingers | - | √ |
Aprile [48] | Italy | 2020 | RCT | Investigation of shoulder pain, motor function, and quality of life in stroke patients after upper limb rehabilitation after robotic or conventional treatment | Stroke | Upper limb | √ | |
Aprile [49] | Italy | 2020 | Before and after | Evaluation of the effect of using three robots and a sensor-based system in the rehabilitation of upper limb disabilities | Stroke | Upper limb | √ | |
Bouteraa [64] | Egypt | 2020 | Case study | Designing and developing a new robotic system for the rehabilitation of the upper extremities | Stroke | Arm, wrist, forearm | √ | |
Kim [50] | US | 2020 | RCT | Investigating the effects of following instructions on upper limb movement status in chronic stroke survivors after using a rehabilitation robot | Stroke | Upper limb | √ | |
Bui [51] | USA | 2021 | Cross-sectional | Investigating the effects of robotic rehabilitation in improving cognitive and movement disorders in adults with HIV and stroke | Stroke | Upper limb | √ | |
Flynn [52] | Australia | 2021 | Not mentioned | Investigating the stability of treatment and rehabilitation of the upper limb with the help of a robot in stroke survivors | Stroke | Upper limb | ||
Terranova [53] | Brazil | 2021 | RCT | Investigating the difference between robot-assisted therapy and restriction-induced movement therapy after using a rehabilitation program by chronic stroke patients. | Stroke | Upper limb | ||
Shi [65] | China. | 2021 | Before and after | Investigating the clinical effectiveness of a soft robotic hand in fingers, wrist and elbow rehabilitation | Stroke | Fingers, wrist and elbow | ||
Chen [73] | China | 2021 | RCT | Investigating the effects of robot-assisted arm training on arm motor performance, one-sided spatial neglect, social participation and daily life activities after stroke | Stroke | Arm | √ | |
Qu [54] | China | 2021 | RCT | Investigating the effect of using robot-assisted training on upper limb function in stroke patients | Stroke | Upper limb | √ | |
Abd [55] | Saudi Arabia | 2022 | RCT | Investigating the effects of rehabilitation exercises provided through games and robots on motor functions and upper limb spasticity in individuals with chronic stroke. | Stroke | Upper limb | √ |
Different levels of upper limb disability | |
---|---|
Level of disability (references) | References frequency |
30 | |
10 | |
7 | |
7 | |
6 | |
6 | |
4 | |
4 |
Variables | References | References frequency | |
---|---|---|---|
Sex
|
Male
| 2 | |
Female
| [43] | 1 | |
Male and female
| 49 | ||
Participant age
|
<=18
| 4 | |
> 18
| 47 | ||
Duration of treatment
|
< 1 month
| 21 | |
1–2 month
| 23 | ||
>= 3 month
| 5 |
Upper limb pasts(references) | References frequency |
---|---|
15 | |
14 | |
12 | |
11 | |
9 | |
9 | |
6 | |
5 | |
2 |
Evaluation types | Evaluation Methods/tools(references) | References frequency | All References for evaluation types | The total frequency of types of evaluation based on the number of references | |
---|---|---|---|---|---|
Evaluation and measurement of upper limb function and dexterity
| 30 | 52 | |||
10 | |||||
11 | |||||
11 | |||||
10 | |||||
9 | |||||
8 | |||||
6 | |||||
6 | |||||
5 | |||||
3 | |||||
3 | |||||
2 | |||||
2 | |||||
2 | |||||
2 | |||||
Physical health Composite Score (PCS) [48] | 1 | ||||
Modified Rankin Scale (MRS) [35] | 1 | ||||
Arm Motor Ability Test (AMAT) [29] | 1 | ||||
Semi-structured interview to assess arm function [36] | 1 | ||||
Patient-Rated Wrist and Hand Evaluation (PRWHE) [63] | 1 | ||||
Arm-Hand Function (AHF) [71] | 1 | ||||
Pediatric Evaluation of Disability Inventory (PEDI) [67] | 1 | ||||
Performance Oriented Mobility Assessment (POMA) [46] | 1 | ||||
Reliable Change Index (RCI) [46] | 1 | ||||
Symbol Digit Modalities Test (SDMT) [49] | 1 | ||||
Total active mobility (TAM) [34] | 1 | ||||
Disability Assessment Scale (DAS) [34] | 1 | ||||
Pegboard test [66] | 1 | ||||
Intrinsic Motivation Inventory (IMI) [71] | 1 | ||||
Spinal Cord Independence(SCI) [71] | 1 | ||||
Assisting Hand Assessment (AHA) [67] | 1 | ||||
World Health Organization Disability Assessment Schedule (WHODAS) [73] | 1 | ||||
Manual Function Test (MFT) [44] | 1 | ||||
Disabilities of Arm, Shoulder, and Hand (DASH) [68] | 1 | ||||
Shoulder Disability Questionnaire (K-SDQ) [75] | 1 | ||||
1 | |||||
Reflective markers [62] | |||||
Grooved Pegboard Test (GP) [51] | 1 | ||||
Range and motor skills and functional strength of the hand
| 7 | 12 | |||
7 | |||||
2 | |||||
Pinch Strength [79] | 1 | ||||
Quality of Movement (QOM) [39] | 1 | ||||
Amadeo® hand muscle strength: Measures of muscle strength using the robotic device [36] | 1 | ||||
Neuropsychological assessment
| 5 | 11 | |||
2 | |||||
Mental health Composite Score (MCS) [48] | 1 | ||||
Behavioral Inattention Test (BIT) [73] | 1 | ||||
Credibility/Expectancy Questionnaire (CEQ) [71] | 1 | ||||
Catherine Bergego Scale (CBS) [73] | 1 | ||||
Rey Osterrieth complex figure test (ROCF) [49] | 1 | ||||
Symbol Digit Modalities Test (SDMT) [49] | 1 | ||||
Oxford Cognitive Screen (OCS) [49] | 1 | ||||
Digit Span Task [49] | 1 | ||||
Tower of London test [49] | 1 | ||||
Trail making test (TMT) [45] | 1 | ||||
Self-Depression Scale (SDS) [34] | 1 | ||||
Quality of life
| 6 | 9 | |||
Short Form Health Survey (SF-36) [48] | 1 | ||||
Nottingham Extended Activities of Daily Living (NEADL) [41] | 1 | ||||
Multiple Sclerosis Quality of Life-54 (MSQOL-54) [36] | 1 | ||||
Quality of Life (Euro-QOl) [28] | 1 | ||||
Lab-based clinical and kinematic
| 2 | 4 | |||
Functional magnetic resonance imaging (fMRI) [43] | 1 | ||||
Functional near infrared spectroscopy (fNIRS) [34] | 1 | ||||
Severity of pain
| Douleur Neuropathique 4 (DN4) [48] | 1 | 3 | ||
2 | |||||
visual analog scale (VAS) [68] | 1 | ||||
Reliability
| Force and position sensors [32] | 1 | 2 | ||
Based on the time required to complete the task, the average velocity of the device during the test, the Global length of the path travelled by the subject during center-out movements, the line integral of the force along the path described by the patient, and the amount of total work directed towards the target [37] | 1 | ||||
Efficiency
| Force and position sensors [32] | 1 | 2 | ||
Motricity Index (MI) [79] | 1 | ||||
Nine Hole Peg Test [79] | 1 | ||||
Grip and Pinch test [79] | 1 | ||||
The quick version of the Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) [79] | 1 | ||||
Feasibility of the use of the system
| Motion analysis of the fingers both with and without the device [77] | 1 | 2 | ||
- Assessment of the side effects by reporting any adverse events occurring during the study by the physiotherapist in regard to the use of Gloreha Professional [79] -Assessment of the level of operator difficulty for the physiotherapist in managing the device by visual analogue scale (VAS) [79] | 1 | ||||
Cost analysis
| - Costs calculation in terms of the time required by healthcare personnel, using the average cost per hour of a physiotherapist per total number of rehabilitation treatments per patient and in terms of the time required by a physiotherapist to take care that the robotic device working correctly during the sessions [79] | 1 | [79] | 1 | |
Tremor Severity Scale
| A clinical rating scale [36] | 1 | 2 | ||
Tremor Severity Scale (TSS) [26] | 1 | ||||
Adherence to rehabilitation exercises
| number of treatment robot sessions and the duration of treatment sessions using the robot over time [52] | 1 | [52] | 1 | |
Usability Testing
| Usefulness, Satisfaction and Ease-of-use(USE) Questioner [71] | 1 | [71] | 1 | |
Patient Satisfaction
| Questionnaire | Usefulness, Satisfaction and Ease-of-use questionnaire (USE) [71] | 1 | [71] | 1 |
Data collation process
Synthesis of results
Ethical considerations
Results
Study selection process
Critical appraisal of individual sources of evidence
Results of the reviewed studies
Evaluations in upper limb rehabilitation robots
Outcomes of using upper limb rehabilitation robots
Outcomes (references) | Outcomes frequency based on the number of references |
---|---|
51 | |
7 | |
6 | |
4 | |
4 | |
3 | |
3 | |
3 | |
3 | |
Performing repetitive and long exercises very easily with the help of the robot [61] | 1 |
Reducing the duration of rehabilitation exercises [62] | 1 |
Increasing adherence to rehabilitation exercises and more participation in treatment processes [52] | 1 |
Improving the quality of life [61] | 1 |
Improving the quality of the rehabilitation process [64] | 1 |