A Randomized Controlled Trial of Augmented Reality with and Without Robotic Priming in Stroke Rehabilitation

Background Robotic therapy (RT) and augmented reality (AR) have each demonstrated benefits for stroke rehabilitation. Despite the potential priming effect of robotics, no study has investigated whether robotic priming of AR provides additive effects compared to AR or conventional therapy. Objective This study examined the effects of AR with and without robotic priming compared with dose-matched control. Methods In this exploratory trial (N = 33), participants were allocated to robotic-primed AR (RT + AR), AR, or conventional therapy (CT). Outcomes were the Fugl-Meyer Assessment–Upper Extremity (FMA-UE), Berg Balance Scale (BBS), Chedoke Arm and Hand Activity Inventory (CAHAI), and Stroke Impact Scale (SIS). Patient-reported pain and fatigue were recorded. Results All groups improved in motor recovery and balance immediately after therapy. RT + AR exceeded AR (p = 0.037, η 2 =0.19) and CT (p = 0.039, η 2 =0.19) on FMA-UE at post-test and remained superior to CT at follow-up (p = 0.03, η 2 =0.20). For the BBS, both RT + AR (p = 0.016, η 2 =0.18) and AR (p = 0.004, η 2 =0.24) outperformed CT at post-test, and AR retained superiority at follow-up (p = 0.02, η 2 =0.21). RT + AR surpassed CT on CAHAI (p = 0.046, η 2 =0.18) and SIS (p = 0.04, η 2 =0.19) at post-test, with a trend favoring RT + AR on SIS at follow-up (p = 0.06, η 2 =0.18). No severe adverse responses were observed. Conclusion Robotic priming of AR improved more than AR and CT in motor impairments. AR was beneficial for improving balance. Results of this study should be interpreted with caution and may not be generalized to stroke survivors with different characteristics. There was a lack of multiplicity adjustments in this small exploratory trial. Further research is needed to validate the findings based on larger multicenter trials.