SYSTEMATIC REVIEW   Open access

European Journal of Physical and Rehabilitation Medicine 2022 August;58(4):530-48

DOI: 10.23736/S1973-9087.22.07404-4

Copyright © 2022 THE AUTHORS

This is an open access article distributed under the terms of the CC BY-NC-ND 4.0 license which allows users to copy and distribute the manuscript, as long as this is not done for commercial purposes and further does not permit distribution of the manuscript if it is changed or edited in any way, and as long as the user gives appropriate credits to the original author(s) and the source (with a link to the formal publication through the relevant DOI) and provides a link to the license.

lingua: Inglese

New technologies promoting active upper limb rehabilitation after stroke: an overview and network meta-analysis

Gauthier EVERARD ^{1, 2}, Louise DECLERCK ¹, Christine DETREMBLEUR ^{1, 2}, Sophie LEONARD ¹, Glenn BOWER ¹, Stéphanie DEHEM ^{1, 2, 3}, Thierry LEJEUNE ^{1, 2, 3} ✉

¹ Section of Health Sciences, Neuro Musculo Skeletal Lab (NMSK), Institute of Experimental and Clinical Research, Catholic University of Louvain, Brussels, Belgium; ² Louvain Bionics, Catholic University of Louvain, Louvain-la-Neuve, Belgium; ³ Service of Physical Medicine and Rehabilitation, Saint-Luc Clinical Universities, Brussels, Belgium

INTRODUCTION: The primary aim of this work was to summarize and compare the effects of active rehabilitation assisted by new technologies (virtual reality [VR], robot-assisted therapy [RAT] and telerehabilitation [TR)) on upper limb motor function and everyday living activity during the subacute and chronic phases of stroke. The secondary aims were to compare the effects of these technologies according to the intervention design (in addition to or in substitution of conventional therapy), the duration of active rehabilitation and the severity of patients’ motor impairments.
EVIDENCE ACQUISITION: Several databases, namely PubMed, Scopus, Embase and Cochrane Library, were searched. Studies were included if they were meta-analyses with a moderate to high level of confidence (assessed with AMSTAR-2) that compared the effects of a new technology promoting active rehabilitation to that of a conventional therapy program among patients with stroke. Network meta-analyses were conducted to compare the effects of the new technologies.
EVIDENCE SYNTHESIS: Eighteen different meta-analyses were selected and fifteen included in the quantitative analysis. In total these 15 meta-analyses were based on 189 different randomized controlled trials. VR (SMD≥0.25; P<0.05), RAT (SMD≥0.29; P≤0.29) and TR (SMD≥-0.08; P≤0.64) were found to be at least as effective as conventional therapy. During the subacute phase, RAT’s greatest effect was observed for patients with severe-moderate impairments whereas VR and TR’s greatest effects were observed for patients with mild impairments. During the chronic phase, the highest effects were observed for patients with mild impairments, for all studies technologies. Network meta-analyses showed that VR and RAT were both significantly superior to TR in improving motor function during the chronic phase but revealed no significant difference between VR, RAT and TR effectiveness on both motor function (during the subacute phase) and activity (during both chronic and subacute phase).
CONCLUSIONS: This overview provides low-to-moderate evidence that rehabilitation assisted with technologies are at least as effective as conventional therapy for patients with stroke. While VR and RAT seem to be more efficient during the subacute phase, all technologies seem to be as efficient as one another in the chronic phase.

KEY WORDS: Stroke; Robotics; Virtual reality; Telerehabilitation