The Effectiveness, Economic Cost and Adoption of Robotic Rehabilitation for Mobility and Functional Ability in Adult Stroke Patients

Abstract

Robotic rehabilitation devices have been developed to assist therapists to rehabilitate stroke patients based on intensive, high repetitions of task specific exercises to train the impaired limbs of patients. In contrast, conventional therapy is labour intensive and places physical strain on therapists when sustaining intense exercises. Hence it is hoped that with robotic assistive devices, better rehabilitation progress can be achieved for patients, together with alleviation of time and physical demands on therapists. However, there are still uncertainties regarding the use of robotic devices. Studies on the clinical effectiveness of robotic devices have presented a mixed picture. Robotic devices are high capital cost items and its economic cost effectiveness is unclear. The adoption of robotic devices into clinical settings is also an area lacking clarity, as these devices do not work alone but are part of a wider spectrum of clinical care that involves clinicians, patients, hospital administrators and device manufacturers. Inadequate, or incomplete interconnection across these domains of clinical care could affect adoption into clinical settings. Given these uncertainties, the aim of this thesis was to examine and investigate the clinical effectiveness, economic cost, and clinical adoption of robotic rehabilitation. The specific research questions were: Can robotic devices help adult stroke patients to regain motor movement of their upper and lower limbs? Can robotic devices rehabilitate adult stroke patients cost economically? What are the clinical views and experiences of utilizing robotic rehabilitation? What are the factors to consider when introducing robotic devices into the clinical care environment? How can findings from the effectiveness, economic cost and adoption studies be aggregated to create a conceptual framework of providing robotic rehabilitation? To determine the effectiveness and cost effectiveness of robotic rehabilitation, two systematic reviews were conducted according to the JBI review methodology. To seek insights regarding its clinical adoption, qualitative descriptive interviews were conducted with therapists to understand their experiences working with robotic devices. The findings of our research show that robotic rehabilitation is not only clinically effective but also economically cost effective, and especially for severely impaired lower limb patients robotic therapy provides better outcomes. The adoption study, which bridges the gap between the effectiveness and economic evidence from systematic reviews and translation into clinical practice, has uncovered a multitude of factors that need to be taken into consideration when introducing robotic rehabilitation into practice. These factors involve not just simply user training for these devices, but also aspects such as workflow processes, interfacing systems, communication strategies to influence adoption, perceived benefits, and attitudes and motivations of users. From the understandings gained from these various streams of research, a conceptual framework on implementing robotic rehabilitation was developed in order to facilitate translation of the research evidence into practice. This thesis contributes new evidence on effectiveness, cost-effectiveness and clinical integration to the global knowledge base about the use of robotic rehabilitation, and ultimately will lead to stroke patients benefiting from robotic rehabilitation and gaining better health outcomes.