Trial reportBMJ open2021
Economic evaluation of robot-assisted training versus an enhanced upper limb therapy programme or usual care for patients with moderate or severe upper limb functional limitation due to stroke: results from the RATULS randomised controlled trial.
Trial report in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled 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.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it.
- A scoping review of the feasibility, usability, and efficacy of digital interventions in older adults concerning physical activity and/or exercise.Frontiers in aging · 2025Pooled it
- Article
- Economic evaluations of outpatient stroke rehabilitation models: a systematic review of evidence, methods, and gaps.EClinicalMedicine · 2026Article
- Smart exoskeleton-assisted rehabilitation after fracture surgery: closed-loop control, personalized load management, and integrated telemonitoring.Frontiers in bioengineering and biotechnology · 2026Review
- Innovations in Diagnosis and Treatment of Coronary Artery Disease.Diagnostics (Basel, Switzerland) · 2025Review
- Breaking down costs: rehabilitation robotics vs. usual care therapy in diverse healthcare models.Scientific reports · 2025Article
- Telerehabilitation using a 2-D planar arm rehabilitation robot for hemiparetic stroke: a feasibility study of clinic-to-home exergaming therapy.Journal of neuroengineering and rehabilitation · 2024Observational
- Economic analysis of digital motor rehabilitation technologies: a systematic review.Health economics review · 2024Review
- Economic Cost of Rehabilitation with Robotic and Virtual Reality Systems in People with Neurological Disorders: A Systematic Review.Journal of clinical medicine · 2024Review
- Cost analysis of technological vs. conventional upper limb rehabilitation for patients with neurological disorders: an Italian real-world data case study.Frontiers in public health · 2024Article
- Robot- and Technology-Boosting Neuroplasticity-Dependent Motor-Cognitive Functional Recovery: Looking towards the Future of Neurorehabilitation.Brain sciences · 2023Article
- Retrospective Robot-Measured Upper Limb Kinematic Data From Stroke Patients Are Novel Biomarkers.Frontiers in neurology · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
22 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo determine whether robot-assisted training is cost-effective compared with an enhanced upper limb therapy (EULT) programme or usual care.
designEconomic evaluation within a randomised controlled trial.
settingFour National Health Service (NHS) centres in the UK: Queen's Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust; Northwick Park Hospital, London Northwest Healthcare NHS Trust; Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde; and North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust.
participants770 participants aged 18 years or older with moderate or severe upper limb functional limitation from first-ever stroke.
interventionsParticipants randomised to one of three programmes provided over a 12-week period: robot-assisted training plus usual care; the EULT programme plus usual care or usual care. MAIN ECONOMIC OUTCOME MEASURES: Mean healthcare resource use; costs to the NHS and personal social services in 2018 pounds; utility scores based on EQ-5D-5L responses and quality-adjusted life years (QALYs). Cost-effectiveness reported as incremental cost per QALY and cost-effectiveness acceptability curves.
resultsAt 6 months, on average usual care was the least costly option (£3785) followed by EULT (£4451) with robot-assisted training being the most costly (£5387). The mean difference in total costs between the usual care and robot-assisted training groups (£1601) was statistically significant (p<0.001). Mean QALYs were highest for the EULT group (0.23) but no evidence of a difference (p=0.995) was observed between the robot-assisted training (0.21) and usual care groups (0.21). The incremental cost per QALY at 6 months for participants randomised to EULT compared with usual care was £74 100. Cost-effectiveness acceptability curves showed that robot-assisted training was unlikely to be cost-effective and that EULT had a 19% chance of being cost-effective at the £20 000 willingness to pay (WTP) threshold. Usual care was most likely to be cost-effective at all the WTP values considered in the analysis.
conclusionsThe cost-effectiveness analysis suggested that neither robot-assisted training nor EULT, as delivered in this trial, were likely to be cost-effective at any of the cost per QALY thresholds considered. TRIAL REGISTRATION NUMBER: ISRCTN69371850.
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