Review Article

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

Table 1

Characteristics of the included studies ().

StudyHealth conditionSourceParticipantsInterventionDuration and frequencyOutcome measuresRobotic device

Byl et al. [35]Individuals with stroke, aged between 25 and 75 years, for at least 6 monthsNot informed
Location: California, San Francisco

Exp RT = robotic therapy unilateral (; age 54.2 (SD 20.5); gender 1 F/4 M)
Exp RT = robotic therapy bilateral (; age 65.2 (SD 5.4); gender 0 F/5 M)
OI = task-specific repetitive training with a physical therapist (; age 59.3 (SD 6.8); gender 1 F/5 M)
Exp RT = robotic therapy unilateral
Exp RT = robotic therapy bilateral
OI = task-specific repetitive training with a physical therapist
Exp RT =90 min/session;
Exp RT =90 min/session;
OI =90 min/session;
Quality of life = Stroke Impact Scale total range 0-100
Follow-up = postintervention (short term)
UL-EXO7
Bilateral and unilateral
Shoulder, elbow, and wrist
Conroy et al. [31]Adults with a diagnosis of chronic stroke, aged ≥18 yearsCommunity-dwelling adults
Location: not informed

Exp RT = robotic therapy planar (; age 57 (SD 12; gender 9 F/11 M)
Exp RT = robotic therapy combined planar with vertical (; age 60 (SD 13); gender 8 F/10 M)
OI = intensive conventional arm exercise program (; age 56 (SD 6.3); gender 9 F/10 M)
Exp RT = robotic therapy planar
Exp RT = robotic therapy combined planar with vertical
OI = intensive conventional arm exercise program
Exp RT =60 min/session;
Exp RT =30 min planar robot+30 min vertical robot/session;
OI =60 min/session;
Participation = Stroke Impact Scale (version 3.0) subscore mobility range 0-100
Follow-up = postintervention and 12 weeks later (short term)
MIT-MANUS
Unilateral
Shoulder and elbow
Dehem et al. [39]Individuals with acute delay since strokeThree Belgian inpatient rehabilitation centers: Cliniques universitaires Saint-Luc (Brussels), Centre Hospitalier Valida (Brussels), and Centre Hospitalier Neurologique William Lennox (Ottignies)
Location: Belgium

Exp RT add = robotic therapy+conventional therapy (; age 67.3 (SD 11.1); gender 12 F/11 M)
OI = conventional therapy (; age 68.6 (SD 19.1); gender 12 F/10 M)
Exp RT add = robotic therapy+conventional therapy
OI = conventional therapy
Exp RT add =25% robotic therapy 45 min/session+75% conventional therapy; 9 wk
OI = 9 wk
Participation = Stroke Impact Scale subscore social participation range 0-100
Follow-up = postintervention and 24 weeks poststroke (medium term)
REAplan robot
Unilateral
Planar end effector
Gilliaux et al. [33]Patients with cerebral palsy, a maximum age of 18 yearsRecruited from a school for children with physical disabilities (Institut Royal de l’Accueil du Handicap Moteur, Brussels, Belgium)
Location: Belgium

Exp RT add = robotic therapy+conventional therapy (; age 10.8 (SD 4.6); gender N/A)
OI = conventional therapy (; age (SD); gender N/A)
Exp RT add = robotic therapy+conventional therapy
OI = conventional therapy
Exp RT = robotic therapy 2/wk+conventional therapy 45 min/session;
; 45 min/session
Participation = Life Habits range 0-10
Follow-up = postintervention (short term)
REAplan
Unilateral
Shoulder and elbow
Klamroth-Marganska et al. [29]Patients with chronic stroke for at least 6 months, aged ≥18 yearsFour clinical centers in Switzerland (Uniklinik Balgrist, Reha Rheinfelden, Zentrum für Ambulante Rehabilitation Zürich, and Zürcher Höhenklinik Wald)
Location: Switzerland

Exp RT = robotic therapy (; age 55 (SD 13); gender 17 F/21 M)
OI = conventional therapy (; age 58 (SD 14); gender 10 F/25 M)
Exp RT = robotic therapy
OI = conventional therapy
Exp RT =45 min/session;
OI =45 min/session;
Quality of life = Stroke Impact Scale total (version 2.0) range 0-100
Follow-up = 8 and 34 weeks after the start of intervention (short term)
ARMin
Unilateral
Elbow wrist and hand
Kutner et al. [37]Patients with subacute stroke, 3 to 9 months poststrokeRecruited from Emory University and the Cleveland Clinic Foundation
Location: Cleveland, United States

Exp RT add = robotic therapy+repetitive task practice (; age 61.9 (SD 13.4); gender 5 F/5 M)
OI = repetitive task practice (; age 51 (SD 11.3); gender 2 F/5 M)
Exp RT add = robotic therapy+repetitive task practice
OI = repetitive task practice
Exp RT add = robotic therapy 30 h+repetitive task practice 30 h; 3/wk
OI =60 h; 3/wk
Participation = Stroke Impact Scale subscore social participation range 0-100
Follow-up = postintervention and 8 weeks later (short term)
Hand Mentor
Unilateral
Wrist and hand
Lo et al. [28]Patients with stroke for at least 6 months, who were 18 years of age or olderRecruited veterans from four participating veterans affairs medical centers
Location: United States

Exp RT = robotic therapy (; age 66 (SD 11); gender 2 F/47 M)
OI = intensive comparison therapy (; age 64 (SD 11); gender 2 F/48 M)
MI = usual care (; age 63 (SD 12); gender 1 F/27 M)
Exp RT = robotic therapy
OI = intensive comparison therapy
MI = usual care (i.e., medical management and clinic visits as needed)
Exp RT =60 min/session,
OI =60 min/session
Quality of life = Stroke Impact Scale total (version 3.0) range 0-100
Follow-up =12 and 36 weeks after randomization (short term)
MIT-MANUS
Unilateral
Shoulder, elbow, wrist, and hand
Page et al. [38]Volunteers with stroke, for at least 12 months, aged between 21 and 75 yearsVolunteers were recruited using approved advertisements distributed to local stroke support groups and outpatient rehabilitation clinics
Location: not informed

Exp RT add = robotic therapy+repetitive task practice (; age 59 (SD 12.9); gender 5 F/3 M)
OI = repetitive task practice (; age 58.5 (SD 9.5); gender 0 F/8 M)
Exp RT add = robotic therapy+repetitive task practice
OI = repetitive task practice
Exp RT add =60 min/session;
OI =60 min/session;
Participation = Stroke Impact Scale subscore social participation range 0-100
Follow-up = 1 week postintervention (short term)
Myomo e100
Unilateral
Elbow
Rodgers et al. [40]Volunteers with stroke aged at least 18 years with moderate or severe upper limb functional limitation, between 1 week and 5 years after their first strokeParticipants were recruited from stroke units, outpatient clinics, day hospitals, community rehabilitation services, local stroke clubs, and primary care of four National Health Service (NHS) centers in the United Kingdom
Location: United Kingdom

Exp RT add = robotic therapy+usual care (; age 59.9 (SD 13.5); gender 101 F/156 M)
OI = conventional therapy enhanced upper limb therapy+usual care (; age 59.4 (SD 14.3); gender 100 F/159 M)
OI = usual care (; age 62.5 (SD 12.5); gender 101 F/153 M)
Exp RT add = robotic therapy+usual care
OI = conventional therapy enhanced upper limb therapy (EULT) program based on repetitive functional task practice+usual care
OI = usual care
Exp RT =45 min/session;
OI =45 min/session;
OI = received usual NHS care, which was provided by their local clinical service
Quality of life = Stroke Impact Scale total (version 3.0) range 0-100
Follow-up = postintervention and 12 weeks later (short term)
MIT-Manus robotic
Gym (shoulder-elbow module, wrist module, and hand module integrated on to the shoulder-elbow module)
Unilateral
Timmermans et al. [32]Patients with chronic stroke for at least 8 months, aged between 18 and 85 yearsRecruited from Adelante Rehabilitation Centre (Hoensbroek, NL)
Location: Netherlands

Exp RT add = robotic therapy+task-oriented training method (; age 61.8 (SD 6.8); gender 3 F/8 M)
OI = arm-hand training program (; age 56.8 (SD 6.4); gender 3 F/8 M)
Exp RT add = robotic therapy+task-oriented training method
OI = arm-hand training program
Exp RT add =30 min/session;
OI =30 min/session;
Quality of life = SF-36 subscore physical health range 0-100
Follow-up = 8 and 24 weeks after the start of intervention (medium term)
Haptic Master
Unilateral
Shoulder and elbow
Volpe et al. [30]Patients with stroke who had impaired arm and hand mobility for at least 6 monthsRecruited at from outpatient clinic
Location: not informed

Exp RT = robotic therapy (; age 62 (SD 3); gender 3 F/8 M)
OI = conventional therapy (; age 60 (SD 3); gender 3 F/7 M)
Exp RT = robotic therapy
OI = conventional therapy
Exp RT =60 min/session;
OI =60 min/session;
Quality of life = Stroke Impact Scale total (version 2.0) range 0-100
Follow-up = postintervention and 12 weeks later (short term)
MIT-MANUS
Unilateral
Shoulder and elbow
Wu et al. [36]Individuals with unilateral chronic stroke, for at least 6 monthsNot informed
Location: not informed

Exp RT = robotic therapy bilateral arm training (; age 55.13 (SD 12.72); gender 4 F/10 M)
OI = therapist-based bilateral arm training (; age 57.04 (SD 8.78); gender 2 F/12 M)
OI = conventional therapy (; age 51.30 (SD 6.23); gender 4 F/10 M)
Exp RT = robotic therapy bilateral arm training
OI = therapist-based bilateral arm training
OI = conventional therapy
Exp RT = 90-105 min/session;
OI = 90-105 min/session;
OI =90-105 min/session;
Quality of life = Stroke Impact Scale total range 0-100
Follow-up = postintervention (short term)
Bi-Manu-Track
Bilateral
Forearm and wrist

 = sample size; SD = standard deviation; exp = experimental group; N/A = not available; M = masculine; F = feminine; RT = robot-assisted therapy; add = additional; OI = other intervention; wk = week(s); yr = year(s); min = minutes; h = hours.