Publication: The effectiveness of robotic rehabilitation therapy on activities of daily living among workers with acquired brain injury
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Date
2022
Authors
Kamdi, Mohd Khairul Anwar
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Abstract
Background: Stroke is one of the leading causes of acquired disability in adults and the sixth leading cause of death worldwide. In Malaysia, there are 50,000 cases of stroke per year, and 40,000 of those cases occur in working-age people. Ageing populations have increased the global need for physical therapy services. Many use the Barthel index self-care evaluation to determine whether a stroke, neuromuscular, or cancer patient can meet their basic needs. This study aims to determine the effectiveness of robotic rehabilitation therapy compared to conventional rehabilitation therapy on Modified Barthel Index (MBI) score and the predictor effect among workers with stroke in East Coast Peninsular Malaysia. Objectives: The first objective of the study was to measure the changes of MBI scores among workers with acquired brain injury who underwent robotic rehabilitation therapy compared to conventional rehabilitation therapy, upon starting therapy (baseline), during therapy (week 2), and at the discharge of therapy (week 4). Secondly, to measure the effect of HADS on the changes of MBI during a 4-week follow-up on intervention in robotic rehabilitation therapy. Thirdly, we would like to determine the mediating effect of HADS between the mRS and MBI score among workers with stroke who underwent robotic rehabilitation therapy. Methodology: A prospective cohort study was implemented in Kelantan, which receives stroke patients throughout east coast Peninsular Malaysia. Each group of robotic and conventional rehabilitation therapy consisted of 50 samples. Robotic rehabilitation therapy comprises of three sessions every day for four weeks. Meanwhile, the conventional rehabilitation therapy group did gait training for two weeks, five days a week, with a weekend rest day. Data was collected at baseline (at admission), week two, and week four (at discharge) for both therapies. The patient's impairment was assessed using the Modified Barthel Index (MBI) by a certified therapist. Modified Rankin Scale (mRS) was the predictor to observe the effect of the rehabilitation outcome. Anxiety and depression that were assessed by Hospital Anxiety and Depression Scale (HADS) was considered the mediator that explained the underlying mechanism of the relationship between mRS and MBI. As for the first objective, Repeated Measures Analysis of Variance (RM-ANOVA) was performed to evaluate the outcome’s changes and compare the changes with both treatment groups. The overall effectiveness was analysed using Generalized Linear Mixed Model (GLMM) for both rehabilitation for second and third objectives. Results: We only managed to recruit 54 acquired brain injury patients to participate in this study. Thirty (55.6%) of these patients received robotic rehabilitation therapy. When we compared for all the characteristics, those who received conventional rehabilitation therapy were significantly older than those who received robotic rehabilitation therapy, while the MBI scores has a significant increased over 4 weeks duration for both therapies. The MBI scores also significantly increased when compared with the treatment group. As for HADS-A, there was a significant difference between the treatment group, in which those in the robotic rehabilitation group had higher HADS-A. When adjusted HADS to the treatment group, there is a decrease in HADS with HADS-Anxiety reduced to 0.22 units and HADS-Depression reduced to 0.28 units although it was not significant. After we add mRS in model 5, it showed that the MBI score improve overtime and those with Poor mRS had lower MBI by 11.15 units. HADS also did not influence the mRS when adjusted with the treatment group when the MBI scores still showed significant improvement with an average of 3.74 units at week 2 from baseline and 5.41 units at week 4 from baseline. Conclusion: Functional recovery occurs in acute stroke patients when the mean Barthel Index score increases from baseline (week 0) to week 2 and then to the time of discharge (week 4) in both therapies. It shows that the activities of daily living improved over time and the psychological status of the workers with acquired brain injury did not affect the level of disability after undergoing robotic rehabilitation therapy. There is no harm or disadvantage in introducing robotic rehab in post-stroke patients. However, evaluation in a larger clinical trial is required to evaluate the effectiveness of this useful adjunct therapy in the stroke population.
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Keywords
Robotic , Rehabilitation