The purpose of this study was to review the effects of robot-assisted therapy (RT) for improving poststroke upper extremity motor impairment. The PubMed, Embase, Medline, and Web of Science databases were searched from inception to April 8, 2020. Randomized controlled trials that were conducted to evaluate the effects of RT on upper extremity motor impairment poststroke and that used Fugl-Meyer assessment for upper extremity scores as an outcome were included. Two authors independently screened articles, extracted data, and assessed the methodological quality of the included studies using the Physiotherapy Evidence Database (PEDro) scale. A random-effects meta-analysis was performed to pool the effect sizes across the studies. Forty-one randomized controlled trials with 1916 stroke patients were included. Compared with dose-matched conventional rehabilitation, RT significantly improved the Fugl-Meyer assessment for upper extremity scores of the patients with stroke, with a small effect size (Hedges g = 0.25; 95% CI, 0.11-0.38; I² = 45.9%). The subgroup analysis revealed that the effects of unilateral RT, but not that of bilateral RT, were superior to conventional rehabilitation (Hedges g = 0.32; 95% CI, 0.15-0.50; I² = 55.9%). Regarding the type of robot devices, the effects of the end effector device (Hedges g = 0.22; 95% CI, 0.09–0.36; I² = 35.4%), but not the exoskeleton device, were superior to conventional rehabilitation. Regarding the stroke stage, the between-group difference (ie, RT vs convention rehabilitation) was significant only for people with late subacute or chronic stroke (Hedges g = 0.33; 95% CI, 0.16-0.50; I² = 34.2%). RT might be superior to conventional rehabilitation in improving upper extremity motor impairment in people after stroke with notable upper extremity hemiplegia and limited potential for spontaneous recovery.

Various factors may interact with functional gains from upper limb motor training in patients with stroke. This study aimed to explore the predictors of upper limb motor recovery in patients with stroke who were admitted to a rehabilitation program. A retrospective, longitudinal observational study was conducted to evaluate the change in Fugl-Meyer assessment upper extremity Score (FMA-UE) at admission and 15 and 30 days after admission. Setting of the study was a rehabilitation hospital. Patients received rehabilitation training during the study period. Demographic information and clinical factors were collected as independent variables. Longitudinal analysis of UE motor recovery measured by FMA-UE over time was performed using the mixed-effects model. Data from 110 participants were included. FMA-UE score showed significant increase (β=4.12, P<0.001). Cognitive functions assessed by the Montreal Cognitive Assessment (MoCA) positively correlated with the improvement in UE functions (β=0.13, P<0.001), while time since stroke negatively correlated with improvement across time (β=-0.05, P=0.019). Patients with subcortical lesions improved faster than those with mixed cortical and subcortical lesions did (difference in slope =2.83, P=0.001). Improvement in patients with moderately impaired UE motor functions was faster than in those with severely impaired UE motor functions (difference in slope =2.74, P=0.016). Severity of hemiplegia, MoCA, and time since stroke were significant predictors in multivariable, mixed-effects models. Initial motor and cognitive impairments may be associated with UE motor recovery in patients admitted to a rehabilitation program. Early assessments of motor and cognitive impairments after stroke would contribute to the prediction of UE motor recovery in patients admitted to a rehabilitation program. The information would also help the stratification of patients for poststroke upper limb rehabilitation trials.