Friday, December 2nd, 2022
Robot-assisted therapy has become increasingly popular over the last 2 decades. In fact, it is so well-known that out of the 1,300 RCT’s in UE stroke recovery, robotic research leads the pack with 112 RCT’s! There is no doubt robotic therapy, in some form or fashion, is here to stay, however is it a MUST-HAVE or a NICE-TO-HAVE intervention?
The Canadian Partnership for Stroke Recovery, led by Dr. Robert Teasell, examined the relevant RCT’s pertaining to robotics and have concluded that robot-assisted therapy, although shows promise, demonstrated “MIXED” or “INCONCLUSIVE” results. Meaning it is NOT considered “Beneficial”.
According to Dr. Teasell, in order for an intervention to be considered “Beneficial” two-thirds (66%) of the studies must report a positive effect. Should hospitals spend, in many cases, hundreds of thousands of dollars on technologies that show “inconclusive” results?
With respect to the upper extremity, the research is clear that interventions including, but not limited to, mirror therapy (47 RCT’s), mental practice (21 RCT’s), task training (25 RCT’s) and CIMT (63 RCT’s) have proven to be “beneficial” (two-thirds or greater of the studies showed a positive effect).
Some may argue that robotics are needed for early initiation of movement for individuals with severe hemiparesis (early Brunnstrom stages). That may be the intent, however, research does not support this notion. Additionally, less expensive alternate solutions such as spring-based arm/hand supports and electrical stimulation can be used.
While there may be benefits to offering robot-assisted therapy interventions to patients suffering from neurological injuries, one should take a step back and look at the larger continuity of care conundrum.
Most of the progress made by a stroke survivor will take place at home. Even if robot-assisted therapy was proven to be beneficial, or superior to other efficacious treatment approaches, the overwhelmingly majority of patients could not afford to purchase a robotic device for their home program.
Perhaps, for the time being, researchers, hospital administrators and clinicians should “reset” the working assumption on why robotics are integrated into the healthcare system and offer more clear expectations. Imagine how much this industry could accomplish if a fraction of the capital dollars spent on robotics was used to create affordable solutions that can realistically be accessible to patients from the acute setting to the home.