Effect of Robot-Assisted Therapy on Participation of People with Limited Upper Limb Functioning: A Systematic Review with GRADE Recommendations

  • Fernanda M. R. M. Ferreira
    Graduate Program in Mechanical Engineering, Universidade Federal de Minas Gerais, Bioengineering Laboratory, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte MG 31270-901, Brazil
  • Maria Emília A. Chaves
    Graduate Program in Physical Therapy, Centro Universitário UNA, Rua Aimorés, 1451, Lourdes, Belo Horizonte MG 30140-071, Brazil
  • Vinícius C. Oliveira
    Graduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Campus JK-MGT 367-Km 583, no. 5000, Alto da Jacuba, Diamantina MG 39100-000, Brazil
  • Jordana S. R. Martins
    Graduate Program in Mechanical Engineering, Pontifícia Universidade Católica de Minas Gerais, Av. Dom José Gaspar, 500-Coração Eucarístico, Belo Horizonte MG 30535-901, Brazil
  • Claysson B. S. Vimieiro
    Graduate Program in Mechanical Engineering, Universidade Federal de Minas Gerais, Bioengineering Laboratory, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte MG 31270-901, Brazil
  • Adriana M. V. N. Van Petten
    Department of Occupational Therapy, Universidade Federal de Minas Gerais, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte MG 31270-901, Brazil

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<jats:p>Background. Previous studies have suggested that robot-assisted therapy (RT) is effective in treating impairment and that it may also improve individuals’ participation. Objective. To investigate the effect of RT on the participation of individuals with limited upper limb functioning (PROSPERO: CRD42019133880). Data Sources: PEDro, Embase, MEDLINE, CINAHL, Cochrane, AMED, and Compendex. Inclusion Criteria. We selected randomized or quasirandomized controlled studies comparing the effects of RT with minimal or other interventions on participation of individuals with limited upper limb functioning. Data Extraction and Synthesis. Methodological quality of the included studies was assessed using the 0-10 PEDro scale, and effect estimates were reported using standardized mean differences (SMDs) with 95% confidence intervals (CIs), and the certainty of the current evidence was assessed using the GRADE. Results. Twelve randomized controlled studies involving 845 participants were included. The estimates of medium effects between RT and minimal intervention (MI) at a short-term follow-up were pooled, but there are no short-term effects between RT and OI. Standardized differences in means were as follows: 0.6 (95% CI 0.1 to 1.2) and 0.2 (95% CI -0.0 to 0.4). There were also no effects of additional RT in the short- or medium-term follow-up periods. Standardized differences in means were as follows: -0.6 (95% CI -1.1 to -0.1) and 0.2 (95% CI -0.3 to 0.8). The methodological quality of the included studies potentially compromised the effect estimates of RT. The existing evidence was very low-quality with many confounding variables between studies. Conclusions. For patients with upper limb neurological dysfunction, low-quality evidence supports RT over MI in terms of improving individual participation in the short term. The existing low- to very low-quality evidence does not support RT over OI in either the short- or medium-term follow-up periods with respect to community participation.</jats:p>

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