INTRODUCTION

Evidence-Based Physical Therapy (EBP) uses the best research evidence with clinical expertise and user’s preferences to produce the most appropriate and effective care. At week 43 in 2024, we had Blended Intensive program (BIP) in Czech Republic, Charles University about EBP. This BIP program opened with welcome words of the president of The European Network of Physiotherapy in Higher Education (ENPHE) and followed with the basis of EBP and teachers who highlighted the main challenges at different Physical Therapy fields.

More than 43 physiotherapy students and 8 teachers from five universities (Savonia University of Applied Sciences, Finland, Universidade da Coruña, Spain, Charles University Prague, Universidad Europea de Madrid, Spain and CEERRF, France), actively participated this week and shared experiential group dynamics and social activities (Picture 1). Students worked together and wrote articles devoted to the following themes: Evidence Based in sport, prevention, injuries, neurological diseases, respiratory diseases, cardiovascular diseases, children and older adults. In this learning task, students practiced conducting a mini review and using PEDro scale to assess the quality of a studies. In the following you can consult the work presented by the students on neurological topic.

BACKGROUND

Patients recovering from stroke often face challenges with stability and walking, while new advancements in rehabilitation technology offer promising ways to improve therapy. This combination of clinical need and technological progress inspired our group project, which we conducted as part of the BIP Erasmus Evidence-Based Physiotherapy Program in Prague. This program brought together students from Spain, France, the Czech Republic, and Finland, allowing us to collaborate, share ideas, and apply evidence-based practices to our research.

With limited time for our project, we narrowed our research question to examine how different physiotherapy methods affect results on the Berg Balance Scale (BBS), a tool commonly used to measure balance in stroke patients. We compared traditional physiotherapy sessions which include strengthening exercises, manual therapy, and techniques to help with upright positioning with robot-assisted physiotherapy to see if one approach showed better outcomes for patients.

METHODS

The aim was to describe differences in S Berg Balance Scale (BBS) results comparing robotic training and conventional physiotherapy.

We used the PICO system:

P population or problem => patients with a stroke

I Intervention => robotic training

C Comparison => conventional physiotherapy

O Outcome of judgement = BBS results

We learned how to use PEDro criterias, how to include/exclude references and how to look at different outcome measures. Importantly we learned how to communicate in our group. We started out by establishing the eligibility criteria for our search. Some of those were determined by the guidelines of the Blended Intensive Programe learning task, such as using only Randomized Controlled Trials. We used following search terms: in title and abstract, RAGT (robotic assisted gait training) AND CPT (conventional physiotherapy). Based on our search, we identified from Pubmed databased seven articlels. After reading titles, we excluded two article because the title doesn´t correspond to our subject.

After literatura search, 5 studies were selected. All of them studied robotic-assisted gait training (RAGT) in comparison with conventional physiotherapy (CPT). Programs varied form 30 minutes to 1 hour, 3 or 5 days a week and 3-4 weeks (only one lasted 5 months).

Some of the most important characteristics of the 5 selected studies that we have chosen were:

1. Yun et al.(2018). 36 participants. Stroke patients with lateropulsion. Intervention: RAGT and CPT. 30 minutes, 5 times/week for 3 weeks.

2. Kang et al. (2021). 30 participants. SUBAR group, 15 control group (CPT). . Intervention: SUBAR-AGT and CPT: 30min, 10 sessions, 3 weeks.

3. Marcia et al. (2018). 19 participants. Stroke with ataxia: 7 robot-assisted, 7 therapist-assisted. Intervention: RAGT and CPT: 60 min, 3 times/week, 5 months.

4. Lee et al. (2022). 47 participants. Post-stroke divided in 4 groups (CPT and RAGT). Intervention: 30 min, 10 sessions, 4 weeks .

5. Bang et al. (2016). 18 participants. Stroke. 9 RAGT, 9 CPT. Intervention: 1h/day, 20 sessions, 5 days/week, 4 weeks.

RESULTS

Our results, however, were not conclusive (Picture 2). The studies we reviewed varied in terms of the number of participants, length and frequency of therapy sessions, and overall rehabilitation time, making it difficult to compare results. One main difference was in the length of physiotherapy sessions. Some studies included both conventional therapy with additional robot-assisted sessions, while others assigned patients only to robot-assisted or traditional therapy groups. These differences made it hard to find clear patterns in the outcomes.

To ensure the quality of our research, we applied strict criteria for selecting studies. Each study had to be directly relevant to our topic and a randomized controlled trial for reliable data. Since physiotherapy is always evolving, we included only studies published within the last ten years, and we avoided using pre-existing meta-analyses to focus on individual research. These requirements made it challenging to find enough articles, showing the need for ongoing research in this area.

CONCLUSION

There were different outcomes in our studies. Robotic training was showing some benefits in BBS scores, but the intensity and length of training should be controlled better in the research. Robot-assisted physiotherapy can help reduce the therapist’s workload and alleviate the patient’s fear of falling during therapy.

Despite these challenges, we concluded that the type of therapy may not matter as much as the overall duration and frequency of sessions. Limited time and resources prevented us from fully addressing all the limitations of our small study. Future research could also look more closely at what “conventional therapy” includes—whether it means soft-tissue techniques, mobilization, or strength training. In the end, the success of therapy likely depends on the approach of each facility and the patient’s motivation. However, we agreed that robot-assisted physiotherapy could be a valuable addition to traditional rehabilitation.

Participating in the BIP Erasmus program was a valuable experience. It gave us insights into evidence-based practice in an international, collaborative environment. Working with students from different countries helped us understand the importance of keeping up with new research, especially in fields as dynamic as physiotherapy and rehabilitation technology.

AUTHORS

Kristiina Koponen physiotherapy student, Savonia, University of Applied Sciences, Kuopio, Finland.

Alicia Piñeiro physiotherapy student, University of A Coruña, A Coruña, Spain

Eliška Nikodemová physiotherapy student, Charles University, Czech Republic

José Tamargo physiotherapy student, Universidad Europea de Madrid, Spain

Sabrina Said physiotherapy student, CEERRF, France.

Dagmar Pavlu, Physiotherapist, Assoc. Prof. Charles University, Czech Republic

Ivana Vláčilová, Physiotherapist, PhD., Charles University, Czech Republic

Marja Äijö, PT, PhD Principal Lecturer of gerontology and rehabilitation, Savonia, University of Applied Sciences, Kuopio, Finland

Veronica Robles García, PhD. PT. OT. Lecturer, University of A Coruña, A Coruña, Spain

Beatriz Martínez Toledo, PT. Lecturer at University of A Coruña, A Coruña, Spain

Montserrat Fernández Pereira, PT, Lecturer at University of A Coruña, A Coruña, A Coruña, Spain

Lorena Canosa Carro, PT, MSc, PhD. Lecturer at Universidad Europea de Madrid, Spain

Adrien Pallot, PT, MSc, Lecturer at CEERRF, France.

REFERENCES

1.Kang, C. J., Chun, M. H., Lee, J., & Lee, J. Y. (2021). Effects of robot (SUBAR)-assisted gait training in patients with chronic stroke: Randomized controlled trial. Medicine, 100(48), e27974. https://doi.org/10.1097/MD.0000000000027974

2.Belas Dos Santos M, Barros de Oliveira C, Dos Santos A, Garabello Pires C, Dylewski V, Arida RM. A Comparative Study of Conventional Physiotherapy versus Robot-Assisted Gait Training Associated to Physiotherapy in Individuals with Ataxia after Stroke. Behav Neurol. 2018 Feb 20;2018:2892065. doi: 10.1155/2018/2892065. PMID: 29675114; PMCID: PMC5838477.

3.Lee J, Chun MH, Seo YJ, Lee A, Choi J, Son C. Effects of a lower limb rehabilitation robot with various training modes in patients with stroke: A randomized controlled trial. Medicine (Baltimore). 2022 Nov 4;101(44):e31590. doi: 10.1097/MD.0000000000031590. PMID: 36343085; PMCID: PMC9646640.

4.Yun, M, Joo, M. Kim, S-C. & Kim, M-S. 2018. Robot-asssted gait training effectively improved lateropulsion in subacute stroke patients: a single-blinded randomized controlled triEur J Phys Rehabil Med . 2018 Dec;54(6):827-836. doi: 10.23736/S1973-9087.18.05077-3

5.Bang, Dae-Hyouk; Shin, Won-Seob . (2016). Effects of robot-assisted gait training on spatiotemporal gait parameters and balance in patients with chronic stroke: A randomized controlled pilot trial. NeuroRehabilitation, 38(4), 343–349. doi:10.3233/NRE-161325