Effectiveness of technology-based stroke interventions to improve upper limb functioning in low- and middle-income countries: a systematic review and meta-analysis

Abstract

BACKGROUND: Stroke is one of the leading causes of disability worldwide, with low- and middle- income countries (LMICs) representing 69% of stroke incidence. Technology-based interventions offer potential for improving motor function and rehabilitation adherence; however, their impact in LMICs remains unknown. OBJECTIVE: To measure the efficacy of technological interventions compared to conventional physical rehabilitation in improving post- stroke upper limb motor function in LMICs. METHODS: We conducted a systematic review (PROSPERO registration: CRD42020213333) of randomized clinical trials (RCTs) from PubMed, Global Index Medicus, and Physiotherapy Evidence Databases. Studies included stroke survivors receiving technological interventions for upper limb rehabilitation. Effectiveness outcomes included upper limb motor function, performance for activities of daily living, and quality of life. A meta-analysis was performed using mean differences (MD) and 95% confidence intervals (95% CI). Risk of bias was assessed using the Cochrane Collaboration tool for RCTs. RESULTS: Fifty studies were included after the screening phase, comprising a total of 2646 participants. Nine technological interventions were evaluated, including: virtual reality (40%), robotics (22%), telerehabilitation (10%), among others. Meta-analysis showed significant effect of immersive virtual reality on upper limb function using the Fugl-Meyer Scale (MD 5.65; 95% CI 4.88 to 6.43) and on daily activity performance using the Functional Independence Measure (MD 4,82; 95% CI 2,45-7,19). A significant difference was also found between telerehabilitation and conventional therapy using the modified Barthel index (MD of 3.28; 95% CI 0.86 to 5.70). CONCLUSIONS: Immersive virtual reality and telerehabilitation are effective interventions compared to conventional rehabilitation in LMICs.