DOI QR코드

DOI QR Code

The Effects of Robot-Assisted Gait Training for the Patient With Post Stroke: A Meta-Analysis

뇌졸중 환자에게 적용한 로봇보행 재활훈련의 효과: 메타분석

  • Park, So-Yeon (Dept. of Physical Therapy, College of Health Sciences, Sangji University)
  • 박소연 (상지대학교 보건과학대학 물리치료학과)
  • Received : 2015.01.20
  • Accepted : 2015.03.12
  • Published : 2015.05.21

Abstract

Robot-assisted rehabilitation therapy has been used to increase physical function in post-stroke patients. The aim of this meta-analysis was to identify whether robot-assisted gait training can improve patients' functional abilities. A comprehensive search was performed of PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Physiotherapy Evidence Database (PEDro), Academic Search Premier (ASP), ScienceDirect, Korean Studies Information Service System (KISS), Research Information Sharing Service (RISS), Korea National Library, and the Korean Medical Database up to April, 2014. Fifteen eligible studies researched the effects of robot-assisted gait training to a control group. All outcome measures were classified by International Classification of Functioning, Disability, and Health (ICF) domains (body function and structures, activity, and participation) and were pooled for calculating the effect size. The overall effect size of the robot-assisted gait training was .356 [95% confidence interval (CI): .186~.526]. When the effect was compared by the type of electromechanical robot, Gait Trainer (GT) (.471, 95% CI: .320~.621) showed more effective than Lokomat (.169, 95% CI: .063~.275). In addition, acute stroke patients showed more improvement than others. Although robot-assisted gait training may improve function, but there is no scientific evidence about the appropriate treatment time for one session or the appropriate duration of treatment. Additional researchers are needed to include more well-designed trials in order to resolve these uncertainties.

Acknowledgement

Supported by : Sangji University

References

  1. Chang WH, Kim MS, Huh JP, et al. Effects of ro bot-assisted gait training on cardiopulmonary fitness in subacute stroke patients: A randomized controlled study. Neurorehabil Neural Repair. 2012;26(4):318-324. http://www.dx.doi.org/10.1177/ 1545968311408916 https://doi.org/10.1177/1545968311408916
  2. Chang WH, Kim YH. Robot-assisted therapy in stroke rehabilitation. J Stroke. 2013;15(3):174-181. https://doi.org/10.5853/jos.2013.15.3.174
  3. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ, Routledge Academic, 1988:24-26.
  4. Cooper H. Research Synthesis and Meta-analysis: A step-by-step approach. 4th ed. CA, SAGE Publication Inc., 2010:111-113.
  5. Cooper H, Hedges LV. The Handbook of Research Synthesis. CA, Russell Sage Foundation, 1994: 301-322.
  6. Dias D, Lains J, Pereira A, et al. Can we improve gait skills in chronic hemiplegics? A randomised control trial with gait trainer. Eura Medicophys. 2007;43(4):499-504.
  7. Duval S, Tweedie R. A nonparametric 'trim and fill' method of accounting for publication bias in meta-analysis. Journal of the American Statistical Association. 2000;95(449):89-98.
  8. Edmans JA, Gladman JR, Cobb S, et al. Validity of a virtual environment for stroke rehabilitation. Stroke. 2006;37(11):2770-2775. https://doi.org/10.1161/01.STR.0000245133.50935.65
  9. Feigin VL, Lawes CM, Bennett DA, et al. Stroke epidemiology: A review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol. 2003;2(1):43-53. https://doi.org/10.1016/S1474-4422(03)00266-7
  10. Fisher S, Lucas L, Thrasher TA. Robot-assisted gait training for patients with hemiparesis due to stroke. Top Stroke Rehabil. 2011;18(3):269-276. http://www.dx.doi.org/10.1310/tsr1803-269 https://doi.org/10.1310/tsr1803-269
  11. Geroin C, Mazzoleni S, Smania N, et al. Systematic review of outcome measures of walking training using electromechanical and robotic devices in patients with stroke. J Rehabil Med. 2013;45(10): 987-996. http://www.dx.doi.org/10.2340/16501977-1234 https://doi.org/10.2340/16501977-1234
  12. Geroin C, Picelli A, Munari D, et al. Combined transcranial direct current stimulation and robotassisted gait training in patients with chronic stroke: A preliminary comparison. Clin Rehabil. 2011;25(6):537-548. http://www.dx.doi.org/10.1177/0269215510389497 https://doi.org/10.1177/0269215510389497
  13. Hidler J, Nichols D, Pelliccio M, et al. Multicenter randomized clinical trial evaluating the effectiveness of the lokomat in subacute stroke. Neurorehabil Neural Repair. 2009;23(1):5-13. http://www.dx.doi.org/10.1177/1545968308326632 https://doi.org/10.1177/1545968308326632
  14. Hornby TG, Campbell DD, Kahn JH, et al. Enhanced gait-related improvements after therapist- versus robotic-assisted locomotor training in subjects with chronic stroke: A randomized controlled study. Stroke. 2008;39(6):1786-1792. http://www.dx.doi.org/10.1161/STROKEAHA.107.504779 https://doi.org/10.1161/STROKEAHA.107.504779
  15. Hsieh YW, Lin KC, Wu CY, et al. Predicting clinically significant changes in motor and functional outcomes after robot-assisted stroke rehabilitation. Arch Phys Med Rehabil. 2014;95(2):316-321. http://www.dx.doi.org/10.1016/j.apmr.2013.09.018 https://doi.org/10.1016/j.apmr.2013.09.018
  16. Husemann B, Muller F, Krewer C, et al. Effects of locomotion training with assistance of a robot- driven gait orthosis in hemiparetic patients after stroke: A randomized controlled pilot study. Stroke. 2007;38(2):349-354. https://doi.org/10.1161/01.STR.0000254607.48765.cb
  17. Hwang S, Easy to Understand the Meta-Analysis. Seoul, Hakjisa, 2014:241-254.
  18. Langhorne P, Bernhardt J, Kwakkel G. Stroke rehabilitation. Lancet. 2011;377(9778):1693-1702. http://www.dx.doi.org/10.1016/S0140-6736(11)60325-5 https://doi.org/10.1016/S0140-6736(11)60325-5
  19. Mayr A, Kofler M, Quirbach E, et al. Prospective, blinded, randomized crossover study of gait rehabilitation in stroke patients using the lokomat gait orthosis. Neurorehabil Neural Repair. 2007; 21(4):307-314. https://doi.org/10.1177/1545968307300697
  20. Mehrholz J, Elsner B, Werner C, et al. Electromechanical-assisted training for walking after stroke. Cochrane Database Syst Rev. 2013;7:CD006185. http://www.dx.doi.org/10.1002/14651858.CD006185.pub3 https://doi.org/10.1002/14651858.CD006185.pub3
  21. Mehrholz J, Werner C, Kugler J, et al. Electromechanical-assisted training for walking after stroke. Cochrane Database Syst Rev. 2007; (4):CD006185.
  22. Morone G, Bragoni M, Iosa M, et al. Who may benefit from robotic-assisted gait training? A randomized clinical trial in patients with subacute stroke. Neurorehabil Neural Repair. 2011;25(7):636-644. http://www.dx.doi.org/10.1177/1545968311401034 https://doi.org/10.1177/1545968311401034
  23. Morone G, Iosa M, Bragoni M, et al. Who may have durable benefit from robotic gait training? A 2-year follow-up randomized controlled trial in patients with subacute stroke. Stroke. 2012; 43(4):1140-1142. http://www.dx.doi.org/10.1161/STROKEAHA.111.638148 https://doi.org/10.1161/STROKEAHA.111.638148
  24. Ng MF, Tong RK, Li LS. A pilot study of randomized clinical controlled trial of gait training in subacute stroke patients with partial bodyweight support electromechanical gait trainer and functional electrical stimulation: Six-month follow-up. Stroke. 2008;39(1):154-160. https://doi.org/10.1161/STROKEAHA.107.495705
  25. Patel MD, Tilling K, Lawrence E, et al. Relationships between long-term stroke disability, handicap and health-related quality of life. Age Ageing. 2006;35(3):273-279. https://doi.org/10.1093/ageing/afj074
  26. Pennycott A, Wyss D, Vallery H, et al. Towards more effective robotic gait training for stroke rehabilitation: A review. J Neuroeng Rehabil. 2012; 9:65. http://www.dx.doi.org/10.1186/1743-0003-9-65 https://doi.org/10.1186/1743-0003-9-65
  27. Peurala SH, Tarkka IM, Pitkanen K, et al. The effectiveness of body weight-supported gait training and floor walking in patients with chronic stroke. Arch Phys Med Rehabil. 2005;86(8): 1557-1564. https://doi.org/10.1016/j.apmr.2005.02.005
  28. Pohl M, Werner C, Holzgraefe M, et al. Repetitive locomotor training and physiotherapy improve walking and basic activities of daily living after stroke: A single-blind, randomized multicentre trial (DEutsche GAngtrainerStudie, DEGAS). Clin Rehabil. 2007;21(1):17-27. https://doi.org/10.1177/0269215506071281
  29. Poli P, Morone G, Rosati G, et al. Robotic technologies and rehabilitation: New tools for stroke patients' therapy. Biomed Res Int. 2013;2013: 153872. http://www.dx.doi.org/10.1155/2013/153872 https://doi.org/10.1155/2013/153872
  30. Physiotherpy Evidence Database. PEDro scale [Internet]. Sydney, 1999 Jun 21 [Cited 2015 Jan 5]. Avaliable from: http://www.pedro.org.au/english/downloads/pedro-scale/
  31. Richardson KM, Rothstein HR. Effects of occupational stress management intervention programs: A meta-analysis. J Occup Health Psychol. 2008;13(1):69-93. http://www.dx.doi.org/10.1037/1076-8998.13.1.69 https://doi.org/10.1037/1076-8998.13.1.69
  32. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics-2011 update: A report from the american heart association. Circulation. 2011;123(4):e18-e209. http://www. dx.doi.org/10.1161/CIR.0b013e3182009701 https://doi.org/10.1161/CIR.0b013e3182009701
  33. Schwartz I, Sajin A, Fisher I, et al. The effectiveness of locomotor therapy using robotic-assisted gait training in subacute stroke patients: A randomized controlled trial. PM&R. 2009;1(6): 516-523. http://www.dx.doi.org/10.1016/j.pmrj.2009.03.009 https://doi.org/10.1016/j.pmrj.2009.03.009
  34. Truelsen T, Piechowski-Jozwiak B, Bonita R, et al. Stroke incidence and prevalence in europe: A review of available data. Eur J Neurol. 2006; 13(6):581-598. https://doi.org/10.1111/j.1468-1331.2006.01138.x
  35. Tong RK, Ng MF, Li LS. Effectiveness of gait training using an electromechanical gait trainer, with and without functional electric stimulation, in subacute stroke: A randomized controlled trial. Arch Phys Med Rehabil. 2006;87(10): 1298-1304. https://doi.org/10.1016/j.apmr.2006.06.016
  36. Westlake KP, Patten C. Pilot study of lokomat versus manual-assisted treadmill training for locomotor recovery post-stroke. J Neuroeng Rehabil. 2009;6:18. http://www.dx.doi.org/10.1186/1743-0003-6-18 https://doi.org/10.1186/1743-0003-6-18