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|Robot-assisted therapy for balance function rehabilitation after stroke: a systematic review and meta-analysis [with consumer summary]|
|Zheng Q-X, Ge L, Wang CC, Ma Q-S, Liao Y-T, Huang P-P, Wang G-D, Xie Q-L, Rask M|
|International Journal of Nursing Studies 2019 Jul;95:7-18|
OBJECTIVE: To identify the rehabilitative effects of robot-assisted therapy on balance function among stroke patients. DESIGN: A systematic review and meta-analysis of randomized controlled trials. DATA SOURCES: Thirteen electronic databases were systematically searched from inception to March 2018: Web of Science, PubMed, Embase, the Cochrane Library, Science Direct, CINAHL, Medline, AMED, Physiotherapy Evidence Database, SPORTDiscus, Wanfang Data, China National Knowledge Infrastructure and Chinese Scientific Journal Database. REVIEW METHODS: Randomized controlled trials were retrieved for identifying the effects of robot-assisted therapy on balance function among stroke patients. Two authors independently searched databases, screened studies, extracted data, and evaluated the methodological quality and risk bias of each included study. A standardized protocol and data-collection form were used to extract information. Effect size was evaluated by mean difference with corresponding 95% confidence intervals. Methodological quality and risk bias evaluation for each included study followed the quality appraisal criteria for randomized controlled trials that were recommended by Cochrane Handbook. Meta-analysis was conducted by utilizing Review Manager 5.3, a Cochrane Collaboration tool. Data was synthesized with descriptive analysis instead of meta-analysis where comparisons were not possible to be conducted with a meta-analysis. RESULTS: Thirty-one randomized controlled trials with a total of 1,249 participants were included. The majority of the included studies contained some methodological flaws. The results of the meta-analysis indicated that robot-assisted therapy produced positive effects on balance function, as shown by an increase in the Berg Balance Scale score (random effects model, mean difference 4.64, 95%CI 3.22 to 6.06, p < 0.01), as well as Fugl-Meyer balance scale scores (fixed effects model, mean difference 3.57, 95%CI 2.81 to 4.34, p < 0.01). After subgroup and sensitivity analyses, the positive effects were not influenced by different types of robotic devices, by whether robot-assisted therapy was combined with another intervention or not, or by differences in duration and intensity of intervention. CONCLUSION: Evidence in the present systematic review indicates that robot-assisted therapy may produce significantly positive improvements on balance function among stroke patients compared with those not using this method. More multi-center, high-quality and large-scale randomized controlled trials following the guidelines of CONSORT are necessary to generate high-quality evidence in further research.