The effectiveness of Single Joint Hybrid Assistive Limb (HAL-SJ) robotic exoskeleton therapy in improving functional outcomes among workers with wrist fractures: a randomized controlled trial

Abstract

Robotic technologies have been developed for motor rehabilitation. Such robots have shown favourable results compared to equivalent doses of usual clinical therapy. Recently, robotic interventions have been suggested for application in orthopaedic rehabilitation for upper extremity disorders, especially those related to the hand and wrist. This study aims to determine the effectiveness of combined conventional therapy and HAL-SJ robotic therapy in restoring wrist functionality following fractures, compared to the standard conventional therapy alone. This trial was conducted at PERKESO Rehabilitation Centre. Thirty-eight individuals with wrist fractures were allocated through simple randomization into two groups, i.e., the control group (conventional therapy) and the intervention group (combination of conventional therapy and robotic HAL-SJ intervention). Both control and intervention groups underwent daily occupational and physiotherapy sessions (90 minutes each), five days a week for four weeks. The intervention group additionally received a 60-minute session of HALSJ robotic therapy alongside conventional treatment. Outcome measures included the Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Measure score, pain, grip and pinch strength, wrist range of motion fingers active range of motion, Purdue Pegboard Test, Box and Block Test, and the Lam Assessment of Stages of Employment Readiness (LASER). Assessments were performed at baseline and after the four-week intervention. Statistical analysis using repeated measure ANOVA revealed significant improvements across all outcome measures in both groups (p<0.001), confirming the effectiveness of the therapies. The results showed that there were significant differences in DASH score (p<0.001), pain intensity (p<0.001), grip strength (p<0.001), pinch strength (p<0.001), wrist active range of motion (p<0.001), fingers active range of motion (p<0.001), Purdue Pegboard Test (p<0.001), and Box and Block Test (p<0.001) after four weeks of interventions in both groups, indicating that both the therapy programmes in the control and intervention groups were effective in improving the functional level and physical performance. However, no significant differences were observed regarding functional level and physical performance between the control and intervention groups. Notably, work readiness in the intervention group improved, with increased participants at the action stage of LASER from 18.4% to 34.2%, while the number of participants in the control group remained at 13 (34.2%). This work can be considered as the starting point for introducing robotic interventions in wrist fracture rehabilitation. This study supports the complementary benefits of incorporating HALSJ robotic therapy into conventional wrist fracture rehabilitation, laying the groundwork for future research and implementation in clinical settings.