Effects of robotic-assisted upper extremity therapy for stroke patients in different recovery phases: a systematic review and meta-analysis

Objective: To systematically evaluate the efficacy of robotic-assisted therapy on upper extremity recovery after stroke through stratified meta-analysis, assessing the influence of disease phase, injury severity, device type, training parameters, and follow-up duration. Methods: We conducted a systematic literature search of PubMed, Embase, Cochrane Library, and Web of Science from inception to July 2025 for randomized controlled trials (RCTs) comparing robotic-assisted with conventional upper limb therapy in adult stroke patients. Results: = 1,678) demonstrated that robotic-assisted therapy significantly improved motor function (Fugl-Meyer Upper Extremity Motor Assessment (FMA-UE)), grip strength (GS), activities of daily living (Modified Barthel Index (MBI)), and social participation (Stroke Impact Scale (SIS)) compared to conventional therapy. Crucially, patients in the subacute phase and those with severe impairment achieved clinically meaningful recovery, with improvements in motor function (FMA-UE: WMD = 8.82, 95% CI (4.42, 13.23)) and activities of daily living (MBI: WMD = 8.00, 95% CI (4.96, 11.03)) exceeding established Minimal Clinically Important Difference (MCID) thresholds. Conclusion: Robotic-assisted therapy significantly improves upper extremity motor function and activities of daily living after stroke, with clinically meaningful gains particularly evident in subacute patients and those with severe impairment. Benefits in grip strength and social participation were statistically significant but of uncertain clinical importance due to methodological limitations. These findings support a stratified rehabilitation approach, prioritizing subacute and severely impaired patients for robotic intervention to maximize functional outcomes. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025640276, CRD42025640276.