Effects of robot-assisted training on balance function in patients with stroke: A systematic review and meta-analysis.

Abstract

ObjectiveTo investigate the effectiveness of robot-assisted therapy on balance function in stroke survivors.Data sourcesPubMed, the Cochrane Library, Embase and China National Knowledge Infrastructure databases were searched systematically for relevant studies.Study selectionRandomized controlled trials reporting robot-assisted therapy on balance function in patients after stroke were included.Data extractionInformation on study characteristics, demographics, interventions strategies and outcome measures were extracted by 2 reviewers.Data synthesisA total of 19 randomized trials fulfilled the inclusion criteria and 13 out of 19 were included in the meta-analysis. Analysis revealed that robot-assisted therapy significantly improved balance function assessed by berg balance scale (weighted mean difference (WMD) 3.58, 95% confidence interval (95% CI) 1.89–5.28, p < 0.001) compared with conventional therapy. Secondary analysis indicated that there was a significant difference in balance recovery between the conventional therapy and robot-assisted therapy groups in the acute/subacute stages of stroke (WMD 5.40, 95% CI 3.94–6.86, p < 0.001), while it was not significant in the chronic stages. With exoskeleton devices, the balance recovery in robot-assisted therapy groups was significantly better than in the conventional therapy groups (WMD 3.73, 95% CI 1.83–5.63, p < 0.001). Analysis further revealed that a total training time of more than 10 h can significantly improve balance function (WMD 4.53, 95% CI 2.31–6.75, p < 0.001). No publication bias or small study effects were observed according to the Cochrane Collaboration tool.ConclusionThese results suggest that robot-assisted therapy is an effective intervention for improving balance function in stroke survivors.LAY ABSTRACTBalance is an important factor in ability to perform independent walking. Many patients with stroke gain little benefit from neural rehabilitation because their balance control is impaired. Robot-assisted therapy is a promising intervention approach, which has developed rapidly in recent years. Several previous reviews have focused on gait-related measurements, such as walking speed and endurance; however, the effectiveness of robot-assisted therapy on balance has not been clearly outlined. This systematic review and meta-analysis showed that robot-assisted therapy can significantly improve balance recovery compared with conventional therapy, especially for people in the acute/subacute phase after stroke treated with an exoskeleton and a total training time of more than 10 h.