Quality-of-Life Change Associated With Robotic-Assisted Therapy to Improve Hand Motor Function in Patients With Subacute Stroke: A Randomized Clinical Trial
American Physical Therapy Association
Kutner, et. al.
Background: At 6 months post-stroke, most patients cannot incorporate their affected hand into daily activities, which in turn is likely to reduce their perceived quality of life.
Objective: This preliminary study explored change in patient-reported, health-related quality of life associated with robotic-assisted therapy combined with reduced therapist-supervised training.
Design and Setting: A single-blind, multi-site, randomized clinical trial was conducted. Participants: Seventeen individuals who were 3 to 9 months post-stroke participated.
Intervention: Sixty hours of therapist-supervised repetitive task practice (RTP) was compared with 30 hours of RTP combined with 30 hours of robotic-assisted therapy.
Measurements: Participants completed the Stroke Impact Scale (SIS) at baseline, immediately post-intervention, and 2 months post-intervention. Change in SIS score domains was assessed in a mixed model analysis.
Results: The combined therapy group had a greater increase in rating of mood from pre-intervention to post-intervention, and the RTP-only group had a greater increase in rating of social participation from pre-intervention to follow-up. Both groups had statistically signiﬁcant improvement in activities of daily living and instrumental activities of daily living scores from pre-intervention to post-intervention. Both groups reported signiﬁcant improvement in hand function post-intervention and at follow-up, and the magnitude of these changes suggested clinical signiﬁcance. The combined therapy group had signiﬁcant improvements in stroke recovery rating post-intervention and at follow-up, which appeared clinically signiﬁcant; this also was true for stroke recovery rating from pre-intervention to follow-up in the RTP-only group.
Limitations: Outcomes of 30 hours of RTP in the absence of robotic-assisted therapy remain unknown.
Conclusion: Robotic-assisted therapy may be an effective alternative or adjunct to the delivery of intensive task practice interventions to enhance hand function recovery in patients with stroke.
- The Hand Mentor provides a viable adjunctive treatment to improve quality of life when limitations to traditional therapy are present.
- The Hand Mentor is an effective adjunct to deliver intensive rehabilitation important in upper limb functional recovery.