Inpatient Robotic Therapy for Stroke Survivors With Severe Upper Limb Impairments: A Randomized Controlled Trial.

IMPORTANCE: Understanding how upper extremity (UE) robotic therapy (RT) affects efficiency and effectiveness of inpatient rehabilitation is important to advancing poststroke treatment and recovery. OBJECTIVE: To determine whether UE RT delivered during inpatient rehabilitation improves strength, function, and mobility of the hemiplegic limb. DESIGN: Multisite open-label randomized controlled trial. SETTING: Two inpatient rehabilitation facilities. PARTICIPANTS: Seventy-two adults were enrolled within 30 days poststroke onset, with fair minus or less muscle strength in shoulder, elbow, and wrist. INTERVENTION: Participants were randomly assigned to RT or non-RT groups. Therapies were delivered within standard daily rehabilitation (3 hr/day). OUTCOMES AND MEASURES: The UE Motor Assessment Scale (UE-MAS), Modified Ashworth Scale, and Manual Muscle Test (MMT) were conducted at baseline and repeated 14 and 21 days after admission. Patients in the RT group completed the Intrinsic Motivation Inventory prior to discharge. Secondary outcomes included self-care and mobility physical function items. RESULTS: Both groups improved over time on the UE-MAS (p < .001), MMT (p ≤ .002), and physical function items (p < .001). RT allowed for 159% increase in repetitions per session but did not lead to greater improvement on the UE-MAS (p =. 639), MMT, or physical function measures compared with controls. Both participants and therapists perceived the intervention as valuable. CONCLUSIONS AND RELEVANCE: Although RT facilitated a higher number of UE repetitions during therapy, outcomes were similar to conventional therapy. Nonetheless, RT was perceived as valuable and should be considered during inpatient rehabilitation for stroke. Plain-Language Summary: This study tested whether patients and clinicians found robotic-assisted therapy valuable and whether it was as effective as traditional therapies in restoring arm movements following stroke. Seventy-two adults with severe arm weakness following a recent stroke participated. Patients were randomly assigned to either robotic therapy or traditional therapy, both given as part of their usual daily inpatient rehabilitation program. Both groups showed improvement in arm strength and movement, as well as in daily activities like self-care and mobility. Patients and therapists enjoyed robotic therapy and found it valuable. Although robotic therapy did not result in better outcomes compared with traditional methods, it was a useful and effective option for inpatients in rehabilitation.