Combined robot-assisted therapy and neuromuscular electrical stimulation in upper limb rehabilitation in patients with stroke: A systematic review of randomized controlled trials

BACKGROUND: Patients with stroke commonly suffer from upper limb dysfunctions that affect their daily activities. Robot-assisted therapy and neuromuscular electrical stimulation have recently been used to improve motor function in patients with stroke. PURPOSE: The purpose of this review is to explore the effects of combined robot-assisted therapy and neuromuscular electrical stimulation on upper limb function post stroke. STUDY DESIGN: Systematic review. METHODS: "PubMed, SCOPUS, CINAHL, EMBASE, and Web of Science" were reviewed until September 2024. Randomized trials that included participants with stroke, compared combined robot-assisted therapy and neuromuscular electrical stimulation with either passive or active control interventions, and evaluated upper limb function--related outcomes were included. The "Physiotherapy Evidence Database (PEDro)" scale was employed to evaluate the methodological quality. RESULTS: Nine studies met the inclusion criteria. In total, 359 participants with stroke (mean age 59.86years) were included in the present review. One study was received an "excellent quality" rating, while eight were considered "good quality" according to the PEDro scale. The results revealed mixed evidence for the influence of combined robot-assisted therapy and neuromuscular electrical stimulation on upper limb function in patients with stroke. CONCLUSIONS: The initial findings indicate that combining robot-assisted therapy and neuromuscular electrical stimulation has potential effects on upper limb function in patients with stroke. More trials are required to recognize the influences of various combined robot-assisted therapy and neuromuscular electrical stimulation treatment protocols on various upper limb poststroke functions.