Evidence map›Paper›PMID 33140719›Full record

Trial reportHealth technology assessment (Winchester, England)2020

Robot-assisted training compared with an enhanced upper limb therapy programme and with usual care for upper limb functional limitation after stroke: the RATULS three-group RCT.

Helen Rodgers, Helen Bosomworth, Hermano I Krebs, Frederike van Wijck, Denise Howel, Nina Wilson, Tracy Finch, Natasha Alvarado, Laura Ternent, Cristina Fernandez-Garcia and 13 more

Registry-linked trialAbstract readMulticenter StudyRandomized Controlled TrialPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Health technology assessment (Winchester, England), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06500611 (Combined Effects Of Sensory Integration And Vestibular Exercises On Dizziness, Fall Risk And Quality Of Life In Post-Stroke Patients), which is not on this map. Cited by 22 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06500611 narecruitingnot on this mapstarted 2024, after this paper: background citation

Combined Effects Of Sensory Integration And Vestibular Exercises On Dizziness, Fall Risk And Quality Of Life In Post-Stroke Patients

TypeinterventionalSponsorRiphah International UniversityRan2024 to 2025Enrolled38ConditionsPost StrokeArmsSensory Integration and Vestibular Exercise with Routine Physical Therapy, Vestibular Exercise with Routine Physical Therapy
3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 4 syntheses or guidelines pooled it.

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  9. Effect of LokomatMedical sciences (Basel, Switzerland) · 2025
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

23 authors.

Helen RodgersStroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.ORCID 0000-0003-3433-4175
Helen BosomworthStroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.ORCID 0000-0002-4670-8827
Hermano I KrebsMechanical Engineering Department, Massachusetts Institute of Technology, Cambridge, MA, USA.ORCID 0000-0002-9317-0900
Frederike van WijckSchool of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.ORCID 0000-0003-0855-799X
Denise HowelPopulation Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.ORCID 0000-0002-0033-548X
Nina WilsonPopulation Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.ORCID 0000-0001-5908-1720
Tracy FinchNursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK.ORCID 0000-0001-8647-735X
Natasha AlvaradoSchool of Healthcare, University of Leeds, Leeds, UK.ORCID 0000-0001-9422-4483
Laura TernentPopulation Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.ORCID 0000-0001-7056-298X
Cristina Fernandez-GarciaPopulation Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.ORCID 0000-0002-7113-225X
Lydia AirdStroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK.ORCID 0000-0002-0578-9309
Sreeman AndoleBarking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK.ORCID 0000-0001-8356-9320
David L CohenLondon North West University Healthcare NHS Trust, London, UK.ORCID 0000-0001-7318-8567
Jesse DawsonInstitute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.ORCID 0000-0001-7532-2475
Gary A FordStroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.ORCID 0000-0001-8719-4968
Richard FrancisStroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.ORCID 0000-0002-6568-1295
Steven HoggLay investigator (contact Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK).
Niall HughesNHS Greater Glasgow and Clyde, Glasgow, UK.ORCID 0000-0001-5555-6442
Christopher I PriceStroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.ORCID 0000-0003-3566-3157
Duncan L TurnerSchool of Health, Sport and Bioscience, University of East London, London, UK.ORCID 0000-0001-8916-4025
Luke ValePopulation Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.ORCID 0000-0001-8574-8429
Scott WilkesSchool of Medicine, University of Sunderland, Sunderland, UK.ORCID 0000-0003-2949-7711
Lisa ShawStroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.ORCID 0000-0002-3435-9519

Funding

Department of Health 11/26/05Medical Research Council MR/K02325X/1
6 · The paper itself

Abstract

backgroundLoss of arm function is common after stroke. Robot-assisted training may improve arm outcomes.

objectiveThe objectives were to determine the clinical effectiveness and cost-effectiveness of robot-assisted training, compared with an enhanced upper limb therapy programme and with usual care.

designThis was a pragmatic, observer-blind, multicentre randomised controlled trial with embedded health economic and process evaluations.

settingThe trial was set in four NHS trial centres.

participantsPatients with moderate or severe upper limb functional limitation, between 1 week and 5 years following first stroke, were recruited.

interventionsRobot-assisted training using the Massachusetts Institute of Technology-Manus robotic gym system (InMotion commercial version, Interactive Motion Technologies, Inc., Watertown, MA, USA), an enhanced upper limb therapy programme comprising repetitive functional task practice, and usual care.

main outcome measuresThe primary outcome was upper limb functional recovery 'success' (assessed using the Action Research Arm Test) at 3 months. Secondary outcomes at 3 and 6 months were the Action Research Arm Test results, upper limb impairment (measured using the Fugl-Meyer Assessment), activities of daily living (measured using the Barthel Activities of Daily Living Index), quality of life (measured using the Stroke Impact Scale), resource use costs and quality-adjusted life-years.

resultsA total of 770 participants were randomised (robot-assisted training,

conclusionsRobot-assisted training did not improve upper limb function compared with usual care. Although robot-assisted training improved upper limb impairment, this did not translate into improvements in other outcomes. Enhanced upper limb therapy resulted in potentially important improvements on upper limb impairment, in performance of activities of daily living, and in mobility. Neither intervention was cost-effective. FUTURE WORK: Further research is needed to find ways to translate the improvements in upper limb impairment seen with robot-assisted training into improvements in upper limb function and activities of daily living. Innovations to make rehabilitation programmes more cost-effective are required. LIMITATIONS: Pragmatic inclusion criteria led to the recruitment of some participants with little prospect of recovery. The attrition rate was higher in the usual care group than in the robot-assisted training or enhanced upper limb therapy groups, and differential attrition is a potential source of bias. Obtaining accurate information about the usual care that participants were receiving was a challenge.

trial registrationCurrent Controlled Trials ISRCTN69371850.

fundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in

Indexed as

RoboticsActivities of Daily LivingAdultAgedCost-Benefit AnalysisFemaleHumansMaleMiddle AgedModels, EconomicQuality-Adjusted Life YearsQuality of LifeRecovery of FunctionSeverity of Illness IndexSingle-Blind MethodState MedicineHEALTH ECONOMIC EVALUATIONPROCESS EVALUATIONRANDOMISED CONTROLLED TRIALREHABILITATIONREPETITIVE TASK PRACTICEROBOT-ASSISTED TRAININGSTROKEUPPER LIMB/ARM

Identifiers

PMID33140719
PMCPMC7682262

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.