Comparative Scoping Review: Robot-Assisted Upper-Limb Stroke Rehabilitation in Low- and Middle-Income Countries Versus High-Income Nations

Abstract

Objective: To examine robotic interventions for upper limb rehabilitation post-stroke, focusing on geographical distribution, stroke chronicity, outcome measures, outcomes of robotic interventions, and publication trends in Low- and Middle-Income Countries (LMICs) compared to High-Income Countries (HICs).

Data sources: Using JBI methodology and PRISMA-ScR guidelines, PubMed, CENTRAL, Embase, CINAHL, and PEDro databases were searched for studies on upper extremity rehabilitation with robotics post-stroke.

Study selection: This review focused on randomized controlled trials (RCTs) published between 2012 and 2024 that examined rehabilitation robots for upper-limb impairments caused by stroke. The studies included adults aged 18 and older in the acute, subacute, or chronic recovery phases. Eligible trials involved using robotic devices, independently or combined with other interventions. Only RCTs with two or more arms were considered, and all included studies were published in English.

Data extraction: Reviewers independently extracted data on study characteristics, stroke chronicity, outcome measures, outcomes of robotic interventions, and temporal trends.

Data synthesis: Of 129 articles meeting the criteria, 107 were from HICs, and 22 were from LMICs. Major contributors from HICs included Italy, Taiwan, and the USA, while China was a significant contributor among LMICs. Most studies focused on chronic stroke patients, with varying assessment tools, the most common being the Fugl-Meyer Upper Extremity Evaluation. Positive outcomes were reported across studies, and recent research activity has increased in both settings.

Conclusions: This review underscores the expanding research on robotic therapy for upper limb rehabilitation in stroke patients, primarily from high-income countries with limited input from low- and middle-income nations. While positive outcomes were frequently observed, disparities between high-income and low-and middle-income countries were clear. The growing research indicates rising interest and advancements in this domain.

Keywords: Stroke; developing countries; rehabilitation; robotics; upper extremity.