ArticleFrontiers in neurology
Telerehabilitation robotics for upper limb rehabilitation after stroke (TRUST): a multi-site pragmatic trial protocol.
Article in Frontiers in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06270459 (Telerehabilitation Robotics for Upper Limb Rehabilitation After STroke), which is not on this map. Not yet cited in PubMed.
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Telerehabilitation Robotics for Upper Limb Rehabilitation After STroke (TRUST): a Study of Multi-cluster Adoption
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22 authors.
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Abstract
Background: Stroke remains a leading cause of long-term disability globally, with upper limb impairment persisting in 39% of survivors at six months. The post-acute rehabilitation gap, characterized by precipitous decline in therapy intensity after hospital discharge, compromises recovery during critical neuroplastic windows. While robot-aided therapy (RAT) demonstrates efficacy comparable to conventional therapy, widespread implementation remains limited by cost, complexity, and facility-based care models. Home-based, minimally supervised RAT with telemonitoring could address these barriers while providing intensive therapy without proportional increases in healthcare resources. Objective: To evaluate the feasibility, acceptability, clinical effectiveness, and cost-effectiveness of home-based minimally supervised RAT using a portable planar robot in patients with moderate upper limb impairment following stroke. Methods: This pragmatic, single-arm, multi-center prospective trial will recruit 54 adults with subacute to chronic stroke (>28 days post-event) with upper extremity impairment (Fugl-Meyer Assessment 10-60) across three tertiary rehabilitation centers in Singapore. The intervention comprises four weeks of intensive home-based, caregiver-supervised training using the H-Man robot (60-120 min daily) with weekly telemonitoring, combined with four conventional occupational therapy sessions over an eight-week treatment period. The primary outcome is utilization rate (≥75% compliance) measured by cloud-based metrics. Secondary outcomes include motor impairment (FMA-UE), functional capacity (ARAT), quality of life (EQ-5D-5L), usability (System Usability Scale), and technology acceptance, assessed at baseline, 6, 8, 12, and 24 weeks. Economic evaluation will assess cost-effectiveness from healthcare system and societal perspectives. Results: Recruitment commenced October 2024 across three Singapore rehabilitation hospitals. The study employs rigorous safety monitoring, standardized training protocols, and cloud-based performance tracking. Preliminary feasibility testing demonstrates acceptable device usability and caregiver support requirements. Conclusion: TRUST addresses critical gaps in post-stroke rehabilitation by evaluating a scalable model combining technology-enabled home therapy with remote clinical oversight. Results will inform implementation strategies for integrating home-RAT into standard care pathways, potentially transforming stroke rehabilitation delivery in resource-constrained healthcare systems facing growing demand from aging populations. Clinical trial registration: ClinicalTrials.gov, identifier NCT06270459.
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