Inclusion, exclusion: The objective for the systematic review was phrased using the Population, Intervention, Comparison and Outcome: P: Patients with stroke, I: effect robotic therapy, C: with traditional occupational/physio-therapy methods O: hand and arm function, spasticity, strength, ADL :RCT study design
Primary outcome:hand and arm function. Secondary outcomes: spasticity, strength, ADL. We exclude literature/systematic reviews, studies with less than 5 subjects, studies prior to 2005. We include publications in English and Scandinavian.
Literature searches: Studies will be systematically searched for in: Medline, Embase, CINAHL, AMED, Cochrane Library. Authors will be contacted for additional information if needed. The search will be repeated prior to submission.
Search terms: The specific search strategies will be created in collaboration with a Medical Science Librarian with expertise in systematic review searching.Primary search terms used to define stroke were Stroke, Stroke rehabilitation, Subacute stroke, Cerebrovascular Accident/s,CVA, Cerebrovascular Apoplexy, Apoplexy, Cerebrovascular, Vascular Accident, Brain, Brain Vascular Accident, Brain Vascular Accidents, Vascular Accidents, Brain Cerebrovascular Stroke, Cerebrovascular Strokes, Apoplexy, Cerebral Stroke, Acute Stroke. Primary terms was paired with secondary terms defining the intervention: Robotics, Robots, Robotic arm rehabilitation, Robotic rehabilitation, Robot-assisted therapy, Robot-aided system, End-effector, Upper limb rehabilitation robot, Arm exoskeleton, Upper limb exoskeleton, Exoskeleton device, Armeo spring, Diego, Armeo Power, Amadeo, ARMin, InMotion, MIT-manus, Barrett UE Robotic Trainer. Terms were paired with a third set of terms related to measure outcome: upper extremity, upper limb, muscle strength, mobility, range of motion, recovery of function, activities of daily living, ADL, arm, hand, finger, wrist, forearm, shoulder, elbow. The search strategy was adapted to the the different databases.
Selection of studies: After removing duplicates, title and abstract will be screened according to inclusion-exclusion criteria, by two independent authors. The two authors using the inclusion-exclusion criteria to exclude those papers that were not relevant to this review will then review full text of references included again. One author,double- checked by a second author, will conduct the initial selection. Any disagreements will be resolved by consensus with a third reviewer. Each selected article will be entered into Endnote and summarized in a table showing: type of robotic device used, age, sex, number of participants, type of stroke, duration of intervention, duration of intervention period, outcome measures, tittle, main author, publication year, country of origin, publication language and setting.
Risk of bias: Assessment of the risk of bias in individual studies will be conducted using the Cochrane risk of bias tool. Studies will be placed within three categories; low, moderate or high risk of bias. The authors will independently conduct the quality appraisal of each included primary study, any disagreement will be resolved by consensus, or a third author will make the conclusion.
Data synthesis: If possible, a meta-analysis will be conducted, and the effect of the intervention reported across the studies will be mathematically pooled according to the recommendations from Cochrane handbook of systematic reviews and meta-analyses. If the included studies use different outcome measures to assess the hand and arm function, Cohen’s d will be used to establish a standardized mean difference index that would be comparable across the included studies. The following subgroup analyses are planned: Type of Stroke,Type of robotic device utilized in the intervention,Intervention duration