Reliability, validity and discriminant ability of the instrumental indices provided by a novel planar robotic device for upper limb rehabilitation

Marco Germanotta,Giorgia Giannarelli,Gabriele Speranza,Arianna Cruciani,Luca Padua,Cristiano Pecchioli,Albino Spedicato,Irene Aprile,Simona Loreti,Francesca Cecchi,Rita Mosca,Matteo Meotti

doi:10.1186/s12984-018-0385-8

Abstract

BackgroundIn the last few years, there has been an increasing interest in the use of robotic devices to objectively quantify motor performance of patients after brain damage. Although these robot-derived measures can potentially add meaningful information about the patient’s dexterity, as well as be used as outcome measurements after the rehabilitation treatment, they need to be validated before being used in clinical practice. The present work aims to evaluate the reliability, the validity and the discriminant ability of the metrics provided by a novel robotic device for upper limb rehabilitation.MethodsForty-eight patients with sub-acute stroke and 40 age-matched healthy subjects were involved in this study. Clinical evaluation included: Fugl-Meyer Assessment for the upper limb, Action Research Arm Test, and Barthel Index. Robotic evaluation of the upper limb performance consisted of 14 measures of motor ability quantifying the dexterity in performing planar reaching movements. Patients were evaluated twice, one day apart, to assess the reliability of the robotic metrics, using the Intraclass Correlation Coefficient. Validity was assessed by analyzing the correlation of the robotic metrics with the clinical scales, by means of the Spearman’s Correlation Coefficient. Finally, the ability of the robotic metrics to distinguish between patients with stroke and healthy subjects was investigated with t-tests and the Effect Size.ResultsReliability was found to be excellent for 12 measures and from moderate to good for the remaining 2. Most of the robotic indices were strongly correlated with the clinical scales, while a few showed a moderate correlation and only one was not correlated with the Barthel Index and weakly correlated with the remain two. Finally, all but one the provided metrics were able to discriminate between the two groups, with large effect sizes for most of them.ConclusionWe found that all the robotic indices except one provided by a novel robotic device for upper limb rehabilitation are reliable, sensitive and strongly correlated both with motor and disability clinical scales. Therefore, this device is suitable as evaluation tool for the upper limb motor performance of patients with sub-acute stroke in clinical practice.Trial registrationNCT02879279.

Highlights

In the last few years, there has been an increasing interest in the use of robotic devices to objectively quantify motor performance of patients after brain damage
Referring to the relative test-retest reliability, Duration, Velocitymean, Lengthtot, Length1, Length4, Length5, Length6, Length7, Length8, Score, Worktot and Worktan displayed an excellent reliability (ICC > 0.9), while a good (ICC ≥ 0.75) and a moderate (ICC ≥ 0.5) reliability was shown by Length2 and Length3 respectively
Discriminant ability The expected ability of the robotic indices to distinguish between patients with subacute stroke and age-matched healthy subjects was confirmed by the results of the statistical analysis

Summary

Introduction

In the last few years, there has been an increasing interest in the use of robotic devices to objectively quantify motor performance of patients after brain damage. Robot – Mediated Therapy has represented one of the most promising approach to restore motor function of upper limb after brain damage [1] mainly because it enables, in comparison with conventional treatment approaches, highly intensive trainings in designed tasks, for extended periods of time [2]. Along with their use as rehabilitation tools, the robotic devices can act as evaluation tools in order to objectively quantify motor performance of patients after brain damage. Even though most of the studies involve patients with stroke [6,7,8,9,10,11,12,13,14], robotic evaluations are used in neurological diseases as Multiple Sclerosis [15], Cerebral Palsy [16, 17], or Ataxia [18]

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