An Economic Analysis of Robot-Assisted Therapy for Long-Term Upper-Limb Impairment After Stroke Effects of Locomotion Training With Assistance of a Robot-Driven Gait Orthosis in Hemiparetic Patients After Stroke: A Randomized Controlled Pilot Study Technology-assisted stroke rehabilitation in Mexico: a pilot randomized trial comparing traditional therapy to circuit training in a Robot/technology-assisted therapy gym The place of robotics in post-stroke rehabilitation Comparison of robotics, functional electrical stimulation, and motor learning methods for treatment of persistent upper extremity dysfunction after stroke: a randomized controlled trial. Effect on arm function and cost of robot-assisted group therapy in subacute patients with stroke and a moderately to severely affected arm: a randomized controlled trial Feasibility and efficacy of a robotic device for hand rehabilitation in hemiplegic stroke patients: a randomized pilot controlled study Power and Sample Size Calculations for Stochastic Cost-Effectiveness Analysis
Background and Purpose — Stroke is a leading cause of disability . Rehabilitation robotics have been developed to aid in recovery after a stroke . This study determined the additional cost of robot-assisted therapy and tested its cost-effectiveness . Methods — We estimated the intervention costs and tracked participants ' healthcare costs . We collected quality of life using the Stroke Impact Scale and the Health Utilities Index . We analyzed the cost data at 36 weeks postr and omization using multivariate regression models controlling for site , presence of a prior stroke , and Veterans Affairs costs in the year before r and omization . Results — A total of 127 participants were r and omized to usual care plus robot therapy ( n=49 ) , usual care plus intensive comparison therapy ( n=50 ) , or usual care alone ( n=28 ) . The average cost of delivering robot therapy and intensive comparison therapy was $ 5152 and $ 7382 , respectively ( P<0.001 ) , and both were significantly more expensive than usual care alone ( no additional intervention costs ) . At 36 weeks postr and omization , the total costs were comparable for the 3 groups ( $ 17 831 for robot therapy , $ 19 746 for intensive comparison therapy , and $ 19 098 for usual care ) . Changes in quality of life were modest and not statistically different . Conclusions — The added cost of delivering robot or intensive comparison therapy was recuperated by lower healthcare use costs compared with those in the usual care group . However , uncertainty remains about the cost-effectiveness of robotic-assisted rehabilitation compared with traditional rehabilitation . Clinical Trial Registration — URL : http:// clinical trials.gov . Unique identifier : NCT00372411 Background and Purpose — The success of gait rehabilitation after stroke depends on active walking exercises . However , the disabling after-effects of stroke often make such exercises impossible at the onset of therapy . To facilitate treadmill training of paraparetic patients , a robot-driven gait orthosis ( Lokomat ) was developed . We investigated the effects of the Lokomat when used with hemiparetic patients . Methods — The authors conducted a r and omized , controlled pilot study of 30 acute stroke survivors . The treatment group received 30 minutes of robotic training daily and the control group 30 minutes of conventional physiotherapy daily in addition to 30 minutes of conventional physiotherapy for each group . Outcome measures were independence of gait , gait speed , gait parameters , and body tissue composition . Results — After 4 weeks of therapy , the walking ability of the Lokomat group and the control group expressed as the functional ambulation classification was significantly improved . The functional ambulation category ( median± interquartile range ) was at baseline 0±0 in control and 0±1 in the therapy group and increased after therapy to 1±3 in both groups significantly ( P=0.01 ) . There was no significant difference in gain of these parameters between the groups . The Lokomat group had a significantly longer single stance phase ( sec ; mean±SEM ) on the paretic leg when walking on the floor . At baseline , it was 0.19±0.17 and after therapy 0.49±0.07 ( P=0.014 ) . The control group had increased their body weight approximately 1.33±1.40 kg ( mean±SEM ; P=0.046 ) , mostly as fat mass , whereas the Lokomat group had lost fat mass approximately −2.9±1.0 kg ( mean±SEM ; P=0.016 ) and increased their muscle mass approximately 3.36±1.4 kg ( mean± SEM ; P=0.031 ) . Conclusions — This pilot study indicates that Lokomat therapy is a promising intervention for gait rehabilitation . Although there was no difference between groups in gain of functional scores , the Lokomat group showed an advantage of robotic training over conventional physiotherapy in improvement of gait abnormality and body tissue composition Background Stroke rehabilitation in low- and middle-income countries , such as Mexico , is often hampered by lack of clinical re sources and funding . To provide a cost-effective solution for comprehensive post-stroke rehabilitation that can alleviate the need for one-on-one physical or occupational therapy , in lower and upper extremities , we proposed and implemented a technology-assisted rehabilitation gymnasium in Chihuahua , Mexico . The Gymnasium for Robotic Rehabilitation ( Robot Gym ) consisted of low- and high-tech systems for upper and lower limb rehabilitation . Our hypothesis is that the Robot Gym can provide a cost- and labor-efficient alternative for post-stroke rehabilitation , while being more or as effective as traditional physical and occupational therapy approaches . Methods A typical group of stroke patients was r and omly allocated to an  intervention ( n = 10 ) or a  control group ( n = 10 ) . The intervention group received rehabilitation using the devices in the Robot Gym , whereas the control group  ( n = 10 ) received time-matched st and ard care . All of the study subjects were subjected to 24 two-hour therapy sessions over a period of 6 to 8 weeks . Several clinical assessment s tests for upper and lower extremities were used to evaluate motor function pre- and post-intervention . A cost analysis was done to compare the cost effectiveness for both therapies . Results No significant differences were observed when comparing the results of the pre-intervention Mini-mental , Brunnstrom Test , and Geriatric Depression Scale Test , showing that both groups were functionally similar prior to the intervention . Although , both training groups were functionally equivalent , they had a significant age difference . The results of all of the upper extremity tests showed an improvement in function in both groups with no statistically significant differences between the groups . The Fugl-Meyer and the 10 Meters Walk lower extremity tests showed greater improvement in the intervention group compared to the control group . On the Time Up and Go Test , no statistically significant differences were observed pre- and post-intervention when comparing the control and the intervention groups . For the 6 Minute Walk Test , both groups presented a statistically significant difference pre- and post-intervention , showing progress in their performance . The robot gym therapy was more cost-effective than the traditional one-to-one therapy used during this study in that it enabled therapist to train up to 1.5 to 6 times more patients for the approximately same cost in the long term . Conclusions The results of this study showed that the patients that received therapy using the Robot Gym had enhanced functionality in the upper extremity tests similar to patients in the control group . In the lower extremity tests , the intervention patients showed more improvement than those subjected to traditional therapy . These results support that the Robot Gym can be as effective as traditional therapy for stroke patients , presenting a more cost- and labor-efficient option for countries with scarce clinical re sources and funding .Trial registration IS RCT N98578807 Reducing the impact of stroke on the independence of elderly patients during daily life is becoming a primary societal goal in developed countries owing to population aging and to the incidence of stroke in elderly people . Rehabilitation plays a fundamental role in reducing the residual motor deficits of stroke patients , both during hospitalization ( acute/subacute phase , inpatient rehabilitation ) and after discharge ( chronic phase , ambulatory/home rehabilitation ) . Since 1995 , when the first pioneering robotic system for rehabilitation was presented , the use of robotics in post-stroke rehabilitation has been investigated intensely , and positive , although not yet fully satisfactory , clinical results were obtained . This article presents the most recent developments in this young research field , outlining the state of the art and the prospect i ve role of robotics in post-stroke rehabilitation OBJECTIVE To compare response to upper-limb treatment using robotics plus motor learning ( ML ) versus functional electrical stimulation ( FES ) plus ML versus ML alone , according to a measure of complex functional everyday tasks for chronic , severely impaired stroke survivors . DESIGN Single-blind , r and omized trial . SETTING Medical center . PARTICIPANTS Enrolled subjects ( N=39 ) were > 1 year postsingle stroke ( attrition rate=10 % ; 35 completed the study ) . INTERVENTIONS All groups received treatment 5d/wk for 5h/d ( 60 sessions ) , with unique treatment as follows : ML alone ( n=11 ) ( 5h/d partial- and whole-task practice of complex functional tasks ) , robotics plus ML ( n=12 ) ( 3.5h/d of ML and 1.5h/d of shoulder/elbow robotics ) , and FES plus ML ( n=12 ) ( 3.5h/d of ML and 1.5h/d of FES wrist/h and coordination training ) . MAIN OUTCOME MEASURES Primary measure : Arm Motor Ability Test ( AMAT ) , with 13 complex functional tasks ; secondary measure : upper-limb Fugl-Meyer coordination scale ( FM ) . RESULTS There was no significant difference found in treatment response across groups ( AMAT : P≥.584 ; FM coordination : P≥.590 ) . All 3 treatment groups demonstrated clinical ly and statistically significant improvement in response to treatment ( AMAT and FM coordination : P≤.009 ) . A group treatment paradigm of 1:3 ( therapist/patient ) ratio proved feasible for provision of the intensive treatment . No adverse effects . CONCLUSIONS Severely impaired stroke survivors with persistent ( > 1y ) upper-extremity dysfunction can make clinical ly and statistically significant gains in coordination and functional task performance in response to robotics plus ML , FES plus ML , and ML alone in an intensive and long- duration intervention ; no group differences were found . Additional studies are warranted to determine the effectiveness of these methods in the clinical setting Objective : To evaluate the effectiveness and efficiency of robot-assisted arm group therapy ( RAGT ) versus individual arm therapy ( IAT ) to restore motor function in the moderately to severely affected patient after stroke . Design : Single blind r and omized controlled trial . Setting : Two in-patient neurological rehabilitation centers . Participants : Fifty first time subacute patients with stroke and a non-functional h and . Intervention : The patients practice d either 30 minutes of RAGT + 30 minutes of IAT ( group A ) or 2x30 minutes of IAT ( group B ) , per workday for four weeks . The RAGT consisted of six workstations enabling repetitive practice of finger , wrist , forearm and shoulder movements . Patients practice d according to their impairment level on at least two workstations per session . The IAT followed the Motor Relearning Programme , enriched by elements of the impairment-oriented training . Main outcome measure : Changes of the Fugl Meyer Score ( FM , 0 - 66 ) between baseline and after 4 weeks , incremental cost effectiveness . Results : Patients were homogeneous at study onset . All patients improved their upper limb motor function over time , but there were no between group differences . The initial ( terminal ) FM scores were 14.6±9.4 ( 25.7±16.5 ) in group A and 16.5±9.8 ( 31.1±19.1 ) in group B. The treatment of a single patient with RAGT cost 4.15 € , compared to 10.00 € for a patient to receive IAT . Conclusion : RAGT in combination with IAT was equally effective as a double session of IAT regarding the restoration of upper limb motor functions in moderate to severely affected subacute patients with stroke .  The treatment costs  for RAGT were less Objective : The purpose of the study was to evaluate the feasibility and efficacy of robot-assisted h and rehabilitation in improving arm function abilities in sub-acute hemiplegic patients . Design : R and omized controlled pilot study . Setting : Inpatient rehabilitation centers . Participants : Thirty hemiplegic stroke patients ( Ashworth spasticity index <3 ) were recruited and r and omly divided into a Treatment group ( TG ) and Control group ( CG ) . Interventions : Patients in the TG received intensive h and training with Gloreha , a h and rehabilitation glove that provides computer-controlled , repetitive , passive mobilization of the fingers , with multisensory feedback . Patients in the CG received the same amount of time in terms of conventional h and rehabilitation . Main outcome measures : H and motor function ( Motricity Index , MI ) , fine manual dexterity ( Nine Hole Peg Test , NHPT ) and strength ( Grip and Pinch test ) were measured at baseline and after rehabilitation , and the differences , ( Δ ) mean(st and ard deviation ) , compared between groups . Results Twenty-seven patients concluded the program : 14 in the TG and 13 in the CG . None of the patients refused the device and only one adverse event of rheumatoid arthritis reactivation was reported . Baseline data did not differ significantly between the two groups . In TG , ΔMI 23(16.4 ) , ΔNHPT 0.16(0.16 ) , ΔGRIP 0.27(0.23 ) and ΔPINCH 0.07(0.07 ) were significantly greater than in CG , ΔMI 5.2(9.2 ) , ΔNHPT 0.02(0.07 ) , ΔGRIP 0.03(0.06 ) and ΔPINCH 0.02(0.03 ) ] ( p=0.002 , p=0.009 , p=0.003 and p=0.038 , respectively ) . Conclusions : Gloreha Professional is feasible and effective in recovering fine manual dexterity and strength and reducing arm disability in sub-acute hemiplegic patients As the data for economic analyses are increasingly collected prospect ively alongside clinical trials , many commentators have highlighted that the sample sizes in such trials should be based on the requirements for the economic analysis as well as those for the clinical evaluation . However , issues associated with sample size calculations for economic analysis have yet to receive the rigorous attention given to sample size calculation for clinical evaluation . In particular , no sample size formula for cost-ef fectiveness analysis is available for analysts hoping either to calculate the required sample size at the design stage of a study or to calculate the power a given size of clinical trial will generate for cost-effectiveness analysis . Building on the recent liter ature for calculating confidence intervals for cost-effectiveness ratios , the authors ex plore possible techniques for deriving a sample size formula for cost-effectiveness analysis based on simple combination of the confidence limits on costs and effects . Key words : cost-effectiveness ; economic analysis ; sample size ; methodology . ( Med Decis Making 1998;18 suppl : S81-S92
Objective : The objective of this review was to examine the economic cost of robotic therapy compared to conventional therapy for adult stroke patients , from the perspective of hospitals .
Introduction : It is important to identify appropriate treatment methods that not only reduce the disability experienced by stroke survivors but also do so cost effectively .
While robotic devices enable a high-intensity training regime for patients , robotic training equipment involves a significant capital outlay for healthcare providers .
Hence , the decision to introduce robotic devices into clinical setting s and offer robotic stroke rehabilitation to patients has an important cost consideration for hospitals .
Inclusion criteria : This review included rehabilitation trials of adult stroke patients ( 18 years and older ) involving robotic devices and comparing the economic outcomes to control groups that used conventional physiotherapy .