Effectiveness of combining robotic therapy and modified constraint-induced movement therapy for moderate to severe upper limb paresis after stroke in subacute phase: Case-control study by propensity score analysis

Introduction: Robotic assisted therapy and modified constraint-induced movement therapy are used evidence-based approach in stroke rehabilitation. However, there is no study showing a combination of robotic assisted therapy and modified constraint-induced movement therapy (combined therapy) in the subacute phase. This study investigated the effectiveness of combined therapy in stroke patients with moderate to severe upper limb paresis compared with conventional occupational therapy at subacute setting. Methods: This research used a case-control study. The intervention group (n = 15) consisting of patients with moderate to severe upper limb paresis (Brunnstrom recovery stage upper extremity III or IV and above hand III) 4-8 weeks since stroke onset received a combined therapy for 3 weeks (total intervention time: 1440 minutes). The control group (n = 15) extracted by propensity score matching received a conventional occupational therapy for 4 weeks (total intervention time: 1680-2240 minutes). The primary outcome was the Fugl-Meyer assessment upper limb score change before and after the intervention. Results: The intervention group exhibited significantly greater improvement on Fugl-Meyer assessment upper lim change (p = 0.005). Conclusion: In the subacute phase, the combined therapy of robotic assisted therapy and modified constraint-induced movement therapy helped improve upper limb motor function more effectively and efficiently than conventional occupational therapy.