Objectives : Bilateral robotic arm training (BRT) may enhance post-stroke motor recovery by reducing interhemispheric inhibition and promoting bilateral motor network engagement. However, previous reviews have often pooled bilateral and unilateral robotic approaches, potential masking differential effects. This systematic review and meta-analysis compared the effects of BRT with unilateral robotic training (URT) and conventional rehabilitation on upper limb motor function after stroke.
Design: Randomized controlled trials were identified through systematic searches of major electronics databases and trial registries in accordance with PRISMA guidelines. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Random-effects meta-analyses were performed using standardized mean differences (SMDs). Predefined subgroup and sensitivity analyses examined the influence of participant characteristics, training dose, intervention duration, and robotic device type.
Results: Fourteen randomized controlled trials involving 440 participants were included. Overall, BRT did not demonstrate a statistically significant advantage over control interventions in upper limb motor function measured by the Fugl-Mayer Assessment for Upper Extremity (SMD=0.18, 95% CI [-0.01, 0.36]). Subgroup analyses identified significant benefits of BRT in participants younger than 60 years (SMD=0.24, 95%CI [0.08, 0.40]), with total training doses exceeding 15 hours (SMD=0.27, 95%CI [0.11,0.43], intervention durations longer than 4 weeks (SMD= 0.37, 95%CI [0.05, 0.69]), and when using Bi-Manu-Tract robotic systems (SMD=0.16, 95%CI [0.04,0.29]).
Conclusion: Although BRT did not provide a significant overall advantage over URT or conventional rehabilitation, its effectiveness appears to depend on patients characteristics, training dose, intervention duration, and device type. These finding support a mechanism-driven and personalized approach to robotic stroke rehabilitation
