{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T18:13:20Z","timestamp":1778523200301,"version":"3.51.4"},"reference-count":43,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Robot-assisted therapy (RAT) can deliver repetitive, feedback-enriched upper-limb practice after stroke, but evidence comparing RAT with dose-matched conventional occupational therapy (COT) under routine inpatient conditions\u2014and concurrent neurocognitive data\u2014remains limited. We compared motor recovery between an end-effector RAT-based program (30 min RAT plus 30 min COT) and dose-matched COT alone in subacute stroke survivors, with neurocognitive outcomes prespecified as exploratory endpoints. Methods: In this single-center retrospective non-randomized cohort study, adults with first-ever ischemic or hemorrhagic stroke who completed routine baseline and week\u22124 assessments received 4 weeks of upper-limb rehabilitation: combined RAT plus COT (60 min daily) or COT alone (60 min daily). The primary outcome was the week-4 Fugl\u2013Meyer Assessment\u2013Upper Extremity (FMA-UE) motor score adjusted for baseline. Primary inference used covariate-adjusted linear regression on outcome-specific complete cases, with a prespecified stabilized inverse probability of treatment weighting (IPTW) average treatment effect analysis as the sensitivity test. Secondary and exploratory endpoints were interpreted descriptively; Benjamini\u2013Hochberg false discovery rate (FDR) control and multiple imputation were applied as supportive analyses. Results: The analytic cohort comprised 65 patients (RAT, n = 33; COT alone, n = 32). Both groups improved over 4 weeks, but the RAT group had worse baseline upper-limb motor status. The adjusted between-group difference for the week-4 FMA-UE motor score was non-significant (adjusted mean difference, 4.39; 95% confidence interval (CI), \u22122.43 to 11.21; p = 0.203), and the stabilized IPTW estimate was concordant (\u03b2 = 2.17; 95% CI, \u22123.63 to 7.98; p = 0.464). In unadjusted analyses, the FMA-UE motor gain was larger after RAT than COT alone (14.70 \u00b1 15.53 vs. 7.91 \u00b1 9.42), and only the RAT group exceeded the prespecified 12.4-point clinically important threshold; this signal attenuated after adjustment. No secondary or exploratory endpoint remained significant after FDR control. Multiple imputation for the primary endpoint was concordant with the complete-case result (pooled \u03b2 = 4.52; 95% CI, \u22121.91 to 10.94; p = 0.168). Conclusions: End-effector RAT did not demonstrate adjusted superiority over dose-matched COT alone for upper-limb motor recovery. The larger unadjusted FMA-UE gain should be interpreted as a descriptive impairment-level signal rather than as evidence of comparative efficacy. Neurocognitive results were exploratory; the retrospective non-randomized design, baseline imbalance, differential missingness, and unavailable confounder data require cautious interpretation.<\/jats:p>","DOI":"10.3390\/jcm15093512","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T07:57:29Z","timestamp":1777967849000},"page":"3512","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Motor Outcomes of Robot-Assisted Versus Conventional Occupational Therapy for Upper-Limb Recovery in Subacute Stroke: A Retrospective Cohort Study with Exploratory Neurocognitive Outcomes"],"prefix":"10.3390","volume":"15","author":[{"given":"Eunju","family":"Na","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, Kwangju Christian Hospital, Gwangju 61661, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sumin","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Kwangju Christian Hospital, Gwangju 61661, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joon Won","family":"Seo","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Kwangju Christian Hospital, Gwangju 61661, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seung Ok","family":"Nam","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Kwangju Christian Hospital, Gwangju 61661, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6805-5727","authenticated-orcid":false,"given":"Eunyoung","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Kwangju Christian Hospital, Gwangju 61661, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dong-Hyuk","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Kwangju Christian Hospital, Gwangju 61661, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunghoon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Kwangju Christian Hospital, Gwangju 61661, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soo-Hyun","family":"Soh","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Kwangju Christian Hospital, Gwangju 61661, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2303-1304","authenticated-orcid":false,"given":"Hyung-Ju","family":"Na","sequence":"additional","affiliation":[{"name":"Seoul-Metropolitan Dongbu Hospital, Seoul 02534, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4906-6089","authenticated-orcid":false,"given":"Younkyung","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Kwangju Christian Hospital, Gwangju 61661, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1016\/S1474-4422(24)00369-7","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990\u20132021: A systematic analysis for the Global Burden of Disease Study 2021","volume":"23","author":"Feigin","year":"2024","journal-title":"Lancet Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1016\/S0140-6736(11)60325-5","article-title":"Stroke rehabilitation","volume":"377","author":"Langhorne","year":"2011","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2181","DOI":"10.1161\/01.STR.0000087172.16305.CD","article-title":"Probability of regaining dexterity in the flaccid upper limb: Impact of severity of paresis and time since onset in acute stroke","volume":"34","author":"Kwakkel","year":"2003","journal-title":"Stroke"},{"key":"ref_4","first-page":"e272","article-title":"Cognitive impairment after ischemic and hemorrhagic stroke: A scientific statement from the American Heart Association\/American Stroke Association","volume":"54","author":"Katzan","year":"2023","journal-title":"Stroke"},{"key":"ref_5","first-page":"389","article-title":"Emerging evidence of the association between cognitive deficits and arm motor recovery after stroke: A meta-analysis","volume":"33","author":"Mullick","year":"2015","journal-title":"Restor. Neurol. Neurosci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1097\/MRR.0000000000000552","article-title":"Cognitive impairment predicts engagement in inpatient stroke rehabilitation","volume":"45","author":"Lowder","year":"2022","journal-title":"Int. J. Rehabil. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S225","DOI":"10.1044\/1092-4388(2008\/018)","article-title":"Principles of experience-dependent neural plasticity: Implications for rehabilitation after brain damage","volume":"51","author":"Kleim","year":"2008","journal-title":"J. Speech Lang. Hear. Res."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Maier, M., Ballester, B.R., and Verschure, P.F. (2019). Principles of neurorehabilitation after stroke based on motor learning and brain plasticity mechanisms. Front. Syst. Neurosci., 13.","DOI":"10.3389\/fnsys.2019.00074"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1806","DOI":"10.1038\/s41598-020-58630-2","article-title":"Comparisons between end-effector and exoskeleton rehabilitation robots regarding upper extremity function among chronic stroke patients with moderate-to-severe upper limb impairment","volume":"10","author":"Lee","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1186\/s12984-020-00746-7","article-title":"Neurocognitive robot-assisted rehabilitation of hand function: A randomized control trial on motor recovery in subacute stroke","volume":"17","author":"Ranzani","year":"2020","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_11","first-page":"CD006876","article-title":"Electromechanical and robot-assisted arm training for improving activities of daily living, arm function, and arm muscle strength after stroke","volume":"11","author":"Mehrholz","year":"2015","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1498","DOI":"10.1016\/j.apmr.2023.02.004","article-title":"Efficacy of robot-assisted training on rehabilitation of upper limb function in patients with stroke: A systematic review and meta-analysis","volume":"104","author":"Yang","year":"2023","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1186\/s12984-025-01662-4","article-title":"Upper limb robotic rehabilitation following stroke: A systematic review and meta-analysis investigating efficacy and the influence of device features and program parameters","volume":"22","author":"Boardsworth","year":"2025","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/S0140-6736(19)31055-4","article-title":"Robot assisted training for the upper limb after stroke (RATULS): A multicentre randomised controlled trial","volume":"394","author":"Rodgers","year":"2019","journal-title":"Lancet"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1310\/tsr18s01-599","article-title":"Estimating the minimal clinically important difference of an upper extremity recovery measure in subacute stroke patients","volume":"18","author":"Verma","year":"2011","journal-title":"Top. Stroke Rehabil."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"541","DOI":"10.3233\/NRE-220149","article-title":"Effects of robotic upper limb treatment after stroke on cognitive patterns: A systematic review","volume":"51","author":"Bressi","year":"2022","journal-title":"NeuroRehabilitation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"26335565231211668","DOI":"10.1177\/26335565231211668","article-title":"Comparing stroke rehabilitation inpatients and clinical trials eligibility criteria: A secondary chart review analysis revealing that most patients could have been excluded from rehabilitation trials based on comorbidity status","volume":"13","author":"Nelson","year":"2023","journal-title":"J. Multimorb. Comorbidity"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Bertoni, D., Bruni, S., Saviola, D., De Tanti, A., and Costantino, C. (2024). The role of cognitive reserve in post-stroke rehabilitation outcomes: A systematic review. Brain Sci., 14.","DOI":"10.3390\/brainsci14111144"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Li, J., Wan, J., and Wang, H. (2024). Role of frailty in predicting outcomes after stroke: A systematic review and meta-analysis. Front. Psychiatry, 15.","DOI":"10.3389\/fpsyt.2024.1347476"},{"key":"ref_20","first-page":"830","article-title":"The association between frailty and stroke rehabilitation outcomes: A cohort study","volume":"39","author":"Cho","year":"2025","journal-title":"Clin. Rehabil."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Ahn, S.Y., Bok, S.-K., Lee, J.Y., Ryoo, H.W., Lee, H.Y., Park, H.J., Oh, H.M., and Kim, T.-W. (2024). Benefits of robot-assisted upper-limb rehabilitation from the subacute stage after a stroke of varying severity: A multicenter randomized controlled trial. J. Clin. Med., 13.","DOI":"10.3390\/jcm13030808"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1016\/j.apmr.2024.01.027","article-title":"The combined effect of robot-assisted therapy and activities of daily living training on upper limb recovery in persons with subacute stroke: A randomized controlled trial","volume":"105","author":"Bhattacharjee","year":"2024","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"111","DOI":"10.12786\/bn.2014.7.2.111","article-title":"Effects of robot-assisted arm training in patients with subacute stroke","volume":"7","author":"Joo","year":"2014","journal-title":"Brain Neurorehabilit."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e98","DOI":"10.1161\/STR.0000000000000098","article-title":"Guidelines for adult stroke rehabilitation and recovery: A guideline for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"47","author":"Winstein","year":"2016","journal-title":"Stroke"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1589\/jpts.31.917","article-title":"Minimal clinically important difference for the Fugl-Meyer assessment of the upper extremity in convalescent stroke patients with moderate to severe hemiparesis","volume":"31","author":"Hiragami","year":"2019","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: A practical and powerful approach to multiple testing","volume":"57","author":"Benjamini","year":"1995","journal-title":"J. R. Stat. Soc. Ser. B (Methodol.)"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"b2393","DOI":"10.1136\/bmj.b2393","article-title":"Multiple imputation for missing data in epidemiological and clinical research: Potential and pitfalls","volume":"338","author":"Sterne","year":"2009","journal-title":"Bmj"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Jakobsen, J.C., Gluud, C., Wetterslev, J., and Winkel, P. (2017). When and how should multiple imputation be used for handling missing data in randomised clinical trials\u2013a practical guide with flowcharts. BMC Med. Res. Methodol., 17.","DOI":"10.1186\/s12874-017-0442-1"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"46","DOI":"10.12786\/bn.2015.8.1.46","article-title":"Clinical outcomes of robot-assisted arm rehabilitation in stroke patients","volume":"8","author":"Kim","year":"2015","journal-title":"Brain Neurorehabilit."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2091","DOI":"10.1038\/s41598-018-20330-3","article-title":"Comparison of proximal versus distal upper-limb robotic rehabilitation on motor performance after stroke: A cluster controlled trial","volume":"8","author":"Hsieh","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e38753","DOI":"10.1097\/MD.0000000000038753","article-title":"Effects of training with a rehabilitation device (Rebless\u00ae) on upper limb function in patients with chronic stroke: A randomized controlled trial","volume":"103","author":"Chang","year":"2024","journal-title":"Medicine"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1177\/154596802401105171","article-title":"The Fugl-Meyer assessment of motor recovery after stroke: A critical review of its measurement properties","volume":"16","author":"Gladstone","year":"2002","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1016\/j.apmr.2008.02.022","article-title":"Estimating minimal clinically important differences of upper-extremity measures early after stroke","volume":"89","author":"Lang","year":"2008","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/1743-0003-11-3","article-title":"A survey on robotic devices for upper limb rehabilitation","volume":"11","author":"Maciejasz","year":"2014","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1053\/mr.2000.3837","article-title":"Brain lesion size and location: Effects on motor recovery and functional outcome in stroke patients","volume":"81","author":"Chen","year":"2000","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.apmr.2005.08.130","article-title":"Determination of the minimal clinically important difference in the FIM instrument in patients with stroke","volume":"87","author":"Beninato","year":"2006","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1177\/1545968306294729","article-title":"Establishing the minimal clinically important difference of the Barthel Index in stroke patients","volume":"21","author":"Hsieh","year":"2007","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1589\/jpts.31.75","article-title":"Minimal clinically important difference for grip strength: A systematic review","volume":"31","author":"Bohannon","year":"2019","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"752","DOI":"10.5535\/arm.2015.39.5.752","article-title":"Relationship between grip and pinch strength and activities of daily living in stroke patients","volume":"39","author":"Bae","year":"2015","journal-title":"Ann. Rehabil. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1161\/STROKEAHA.121.034478","article-title":"Less-affected hand function is associated with independence in daily living: A longitudinal study poststroke","volume":"53","author":"Barel","year":"2022","journal-title":"Stroke"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Ko, M.-J., Chuang, Y.-C., Ou-Yang, L.-J., Cheng, Y.-Y., Tsai, Y.-L., and Lee, Y.-C. (2023). The application of soft robotic gloves in stroke patients: A systematic review and meta-analysis of randomized controlled trials. Brain Sci., 13.","DOI":"10.3390\/brainsci13060900"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1177\/15459683231166939","article-title":"New artificial intelligence-integrated electromyography-driven robot hand for upper extremity rehabilitation of patients with stroke: A randomized, controlled trial","volume":"37","author":"Murakami","year":"2023","journal-title":"Neurorehabilit. Neural Repair"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1177\/15459683241257519","article-title":"Task-oriented training by a personalized electromyography-driven soft robotic hand in chronic stroke: A randomized controlled trial","volume":"38","author":"Shi","year":"2024","journal-title":"Neurorehabilit. Neural Repair"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3512\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T17:37:51Z","timestamp":1778521071000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3512"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,4]]},"references-count":43,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15093512"],"URL":"https:\/\/doi.org\/10.3390\/jcm15093512","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,4]]}}}