The economic cost of robotic rehabilitation for adult stroke patients: a systematic review.

Abstract

The objective of this review was to examine the economic cost of robotic therapy compared to conventional therapy for adult stroke patients, from the perspective of hospitals. It is important to identify appropriate treatment methods that not only reduce the disability experienced by stroke survivors but also do so cost effectively. While robotic devices enable a high-intensity training regime for patients, robotic training equipment involves a significant capital outlay for healthcare providers. Hence, the decision to introduce robotic devices into clinical settings and offer robotic stroke rehabilitation to patients has an important cost consideration for hospitals. This review included rehabilitation trials of adult stroke patients (18 years and older) involving robotic devices and comparing the economic outcomes to control groups that used conventional physiotherapy. We searched major databases such as PubMed, Embase and CINAHL for trial studies conducted from year 2000 and published in English. Included studies were critically appraised, and data were extracted and synthesized using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). Five studies with 213 patients were included in this review. Four studies examined upper limb interventions, and one study evaluated both upper limb and lower limb interventions. Of the five studies, two included acute/sub-acute patients and three included chronic patients. The overall methodological quality of the studies was of a moderate level. The included studies compared the cost of providing robotic intervention against the cost of providing conventional therapy in dose-matched therapy sessions and computed the cost measures in terms of cost per patient session or cost per patient. We performed a cost comparison of the various studies and reviewed the data based on two approaches: the dominance ranking framework and the dominance ranking score. By comparing the cost outcome of each study, four of the five studies showed better cost benefits for the robotic intervention group. Under the dominance ranking framework and the dominance ranking score, the overall dominance levels for most sub-groups favored robotic intervention. Our review indicated that robotic therapy had a better economic outcome than conventional therapy. For patients with severe disability from significant stroke, a moderate dominance favoring robotic therapy for health benefit was found, and a strong dominance for robotic therapy for cost benefit was found. However, the limited number of studies in the review required us to view the results with caution. Key sensitivity factors affecting robotic therapy were the number of patients who could be treated per robotic session and the time therapists spent with patients during a robotic session. Robotic therapy could be prescribed primarily for patients with severe impairment after stroke. To maximize the cost economics, hospital providers may wish to organize their robotic therapy programs based on cost-sensitivity factors. For further research, we suggest better collaboration in methods within this field to enable a more comparable cost computation across studies.