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 poststroke, focusing on geographic distribution, stroke chronicity, outcome measures, outcomes of robotic interventions, and publication trends in low- and middle-income countries (LMICs) compared with high-income countries (HICs).

Data sources: Using Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines, PubMed, CENTRAL, Embase, CINAHL, and PEDro databases were searched for studies on upper extremity rehabilitation with robotics poststroke.

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 years in the acute, subacute, or chronic recovery phases. Eligible trials involved using robotic devices, independently or combined with other interventions. Only RCTs with 2 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, whereas China was a significant contributor among LMICs. Most studies focused on patients with chronic stroke, 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 patients with stroke, primarily from HICs with limited input from low- and middle-income nations. Although 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.