Table 3.
Clinical characteristics of the included studies.
| Study | Location | Disease | Setting | Sample | Male/Female | Age, Mean ± SD | Technology/Body Part | Total Training Hours (or Protocol) | Type of Economic Cost Study |
|---|---|---|---|---|---|---|---|---|---|
| Hesse et al., 2014 [18] | Germany | Stroke | Clinical setting | 50 subacute stroke patients: n = 25 (robot-assisted group therapy + individual arm therapy) n = 25 (two sessions of individual arm therapy) |
13/12 15/10 |
71.4 ± 15.5 69.7 ± 16.6 |
Robot/upper limb | Experimental group: 30 min of robot therapy + 30 min of individual arm therapy per workday for four weeks; supervised by a therapy assistant Control group: 2 × 30 min of individual arm therapy per workday for four weeks; supervised by an experienced therapist |
Cost minimization Cost benefit Description of costs |
| Bustamante et al., 2016 [19] | Mexico | Stroke | Clinical setting | 20 chronic stroke patients: n = 10 (traditional therapy) n = 10 (Robot Gym) |
4/6 3/7 |
64.1 ± 8.38 44.1 ± 12.55 |
Robot/upper limb and lower limb | 24 two-hour therapy sessions over a period of 6 to 8 weeks for all study subjects | Cost-effectiveness Description of costs |
| McCabe et al., 2015 [20] | USA | Stroke | Clinical setting | 35 chronic stroke patients: n = 11 (motor learning) n = 12 (robot + motor learning) n = 12 (FES + motor learning) |
6/5 10/2 7/5 |
NR NR NR |
Robot/upper limb | 5 days/week for 5 h/day (60 sessions) for all groups | Cost-effectiveness Description of costs |
| Wagner et al., 2011 [21] | USA | Stroke | Clinical setting | 127 chronic stroke patients: n = 49 (robot) n = 50 (intensive comparison therapy) n = 28 (usual care) |
47/2 48/2 27/1 |
66 ± 11 64 ± 11 63 ± 12 |
Robot/upper limb | Three 1 h sessions per week for 12 weeks, 36 sessions in total | Cost minimization Cost utility Description of costs |
| Masiero et al., 2014 [22] | Italy | Stroke | Clinical setting | 35 acute stroke patients: n = 17 (robot) n = 18 (robot plus exercise with unimpaired upper limb) 21 acute stroke patients: n = 11 (robot) n = 10 (usual care) 30 acute stroke patients: n = 14 (robot + usual care) n = 16 (usual care) |
10/7 11/7 9/2 7/3 10/4 10/6 |
63.4 ± 11.8 68.8 ± 10.5 72.4 ± 7.1 75.5 ± 4.8 65.6 ± 9.2 66.83 ± 7.9 |
Robot/upper limb | Two daily sessions of 25 min each with robot, for 5 days per week. The two protocols were compared (in terms of number of weeks). | Cost-effectiveness Description of costs |
| Housley et al., 2016 [23] | USA | Stroke | Home | 20 chronic stroke patients: n = 10 (upper limb robot) n = 10 (lower limb robot) |
9/1 10/0 |
63.4 ± 9.1 70.6 ± 12.7 |
Robot/upper limb and lower limb | Each person was instructed to start at lower daily activity levels (one hour), progressing to the standard two-hour therapy dosage within the first week, which was continued for the three-month study duration. Due to the scheduling flexibility of the robotic device, participants were able to complete the two hours of daily prescribed robotic rehabilitation in any permutation. | Cost utility Cost benefit Description of costs |
| Chan et al., 2022 [24] | China | Stroke | Clinical setting | NR | NR | NR | Robot/lower limb | NR | Cost minimization Cost benefit Description of costs |
| Fernández-García et al., 2021 [25] | UK | Stroke | Clinical setting | 770 acute and chronic stroke patients: n = 257 (robot-assisted training plus usual care) n = 259 (EULT programme plus usual care) n = 254 (usual care) |
156/101 159/100 153/101 |
59.9 ± 13.5 59.4 ± 14.3 62.5 ± 12.5 |
Robot/upper limb | Robot-assisted training: 45 min per day, three days per week for 12 weeks, in addition to usual care EULT: 45 min per day, 3 days per week for 12 weeks, in addition to usual care Usual care: 12-week period |
Cost minimization Cost-effectiveness Cost utility Description of costs |
| Rodgers et al., 2020 [26] | UK | Stroke | Clinical setting | 770 acute and chronic stroke patients: n = 257 (robot-assisted training plus usual care) n = 259 (EULT programme plus usual care) n = 254 (usual care) |
156/101 159/100 153/101 |
59.9 ± 13.5 59.4 ± 14.3 62.5 ± 12.5 |
Robot/upper limb | Robot-assisted training: 45 min per day, three days per week for 12 weeks, in addition to usual care EULT: 45 min per day, 3 days per week for 12 weeks, in addition to usual care Usual care: 12-week period |
Cost minimization Cost effectiveness Cost utility Description of costs |
| Pinto et al., 2023 [27] | USA | Spinal cord injury | Clinical setting | 99 SCI patients: n = 67 SCI patients (conventional training) n = 32 SCI patients (overground robotic training) |
46/21 20/12 |
42 ± 16 33 ± 13 |
Robot/lower limb | Authors declared that “training was not standardized as is typical in practice-based evidence design”. Around 60 min for robotic intervention versus 45 min for the overground group. Donning and doffing of the robotic exoskeleton added non-therapeutic time (potentially 40 min). The overground robotic training group had greater training times. | Cost utility Description of costs |
| Lloréns et al., 2015 [28] | Spain | Stroke | Clinical setting versus at home | 30 chronic stroke patients: n = 15 (in-clinic rehabilitation using VR) n = 15 (at-home intervention using VR) |
10/5 7/8 |
55.47 ± 9.63 55.60 ± 7.29 |
Virtual reality/lower limb | Twenty 45 min training sessions conducted 3 times a week for 8 weeks. Both groups received conventional physical therapy in a clinic. | Cost minimization Description of costs |
| Islam et al., 2019 [29] | Denmark, Norway and Belgium | Stroke | Clinical setting | 102 subacute stroke patients: n = 50 (VR training) n = 52 (conventional training) |
NR NR |
NR NR |
Virtual reality/upper limb | Sixteen 60 min sessions over 4 weeks | Cost minimization Cost benefit Description of costs |
| Adie et al., 2017 [30] | UK | Stroke | Home | 235 subacute stroke patients: n = 117 (Wii ® intervention) n = 118 (arm exercises at home) |
66/51 65/53 |
66.8 ± 14.6 68.0 ± 11.9 |
Virtual reality/upper limb | Daily sessions for six weeks | Cost minimization Cost benefit Description of costs |
| Thomas et al., 2017 [31] | UK | Multiple sclerosis | Home | 30 MS patients (EDSS NR): n = 15 (Nintendo Wii + usual care) n = 15 (usual care) |
1/14 2/13 |
50.9 ± 8.08 47.6 ± 9.26 |
Virtual reality/upper and lower limb | 12 months and 6 months of treatment for each group, respectively. Rest of the protocol data were NR. | Cost minimization Description of costs |
| Farr et al., 2021 [32] | UK | Cerebral palsy | Home | 30 cerebral palsy patients (GMFCS levels I–II): n = 15 (supervised VR group) n = 15 (unsupervised VR group) |
12/3 10/5 |
27% <11 years 27% >11 years |
Virtual reality/lower limb | 12 weeks of treatment (rest of the protocol data were NR). | Cost minimization |
EDSS: Expanded Disability Status Scale; GMFCS: Gross Motor Function Classification System; n: sample size; NR: not recorded; SD: standard deviation; SCI: spinal cord injury; VR: virtual reality.