Multicenter randomized trial of robot-assisted rehabilitation for chronic stroke: methods and entry characteristics for VA ROBOTICS.
BACKGROUND
Chronic upper extremity impairment due to stroke has significant medical, psychosocial, and financial consequences, but few studies have examined the effectiveness of rehabilitation therapy during the chronic stroke period.


OBJECTIVE
. To test the safety and efficacy of the MIT-Manus robotic device for chronic upper extremity impairment following stroke.


METHODS
. The VA Cooperative Studies Program initiated a multicenter, randomized, controlled trial in November 2006 (VA ROBOTICS). Participants with upper extremity impairment >/=6 months poststroke were randomized to robot-assisted therapy (RT), intensive comparison therapy (ICT), or usual care (UC). RT and ICT consisted of three 1-hour treatment sessions per week for 12 weeks. The primary outcome was change in the Fugl-Meyer Assessment upper extremity motor function score at 12 weeks relative to baseline. Secondary outcomes included the Wolf Motor Function Test and the Stroke Impact Scale.


RESULTS
. A total of 127 participants were randomized: 49 to RT, 50 to ICT, and 28 to UC. The majority of participants were male (96%), with a mean age of 65 years. The primary stroke type was ischemic (85%), and 58% of strokes occurred in the anterior circulation. Twenty percent of the participants reported a stroke in addition to their index stroke. The average time from the index stroke to enrollment was 56 months (range, 6 months to 24 years). The mean Fugl-Meyer score at entry was 18.9.


CONCLUSIONS
. VA ROBOTICS demonstrates the feasibility of conducting multicenter clinical trials to rigorously test new rehabilitative devices before their introduction to clinical practice. The results are expected in early 2010.
Lo
Albert C
AC
Providence VA Medical Center, Brown University, VA RR&D Center of Excellence-Center for Restorative and Regenerative Medicine, Providence, Rhode Island. Albert.Lo@va.gov
Guarino
Peter
P
Krebs
Hermano I
HI
Volpe
Bruce T
BT
Bever
Christopher T
CT
Duncan
Pamela W
PW
Ringer
Robert J
RJ
Wagner
Todd H
TH
Richards
Lorie G
LG
Bravata
Dawn M
DM
Haselkorn
Jodie K
JK
Wittenberg
George F
GF
Federman
Daniel G
DG
Corn
Barbara H
BH
Maffucci
Alysia D
AD
Peduzzi
Peter
P
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001132:Arm / Q000502:physiology; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities / Q000295:instrumentation*; D020127:Recovery of Function; D012371:Robotics; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome