Condition category
Circulatory System
Date applied
Date assigned
Last edited
Prospectively registered
Overall trial status
Recruitment status
No longer recruiting
Publication status

Plain English Summary

Background and study aims
Loss of the ability to use the arm is a common and distressing consequence of stroke. Currently it is unclear how best to provide therapy to improve arm recovery and function. Research suggests that robot-assisted training may be beneficial but this is not yet proven and further research is needed. Robot-assisted training consists of the use of a machine or 'robot' to exercise the arm. The aim of this study is to find out whether robot-assisted training improves arm function after stroke. Robot assisted training is compared to an enhanced upper limb therapy programme consisting of repeated practice of everyday activities using the arm and usual NHS rehabilitation.

Who can participate?
Adults aged over 18 who have had a stroke which has resulted in difficulty using the arm.

What does the study involve?
Participants are randomly allocated to either robot-assisted training, enhanced upper limb therapy or usual NHS rehabilitation. Robot-assisted training and enhanced upper limb therapy are provided for 45 minutes, 3 times per week for 12 weeks. Robot-assisted training uses a machine to exercise the shoulder/elbow, wrist and hand. Enhanced upper limb therapy involves practicing everyday activities. Usual NHS rehabilitation may involve a range of rehabilitation treatments according to individual clinical need. The effects of the treatments are evaluated by comparing the arm function of patients in each group.

What are the possible benefits and risks of participating?
It is not known whether robot assisted training or enhanced upper limb therapy are effective for improving arm function after stroke. However, research has suggested that increasing therapy, in particular repetitive exercise therapy which is used in both robot-assisted training and enhanced upper limb therapy may improve arm function. It is thought that increasing repetitive exercise in rehabilitation may be beneficial, but this is not yet proven.

Where is the study run from?
The study is being run from Newcastle University, Newcastle upon Tyne, UK. Stroke patients from four areas of the UK are invited to take part (Newcastle/Northumbria, Romford, Glasgow and Cambridge).

When is the study starting and how long is it expected to run for?
April 2014 to January 2018

Who is funding the study?
National Institute for Health Research (NIHR) (UK)

Who is the main contact?
Dr Helen Bosomworth

Trial website

Contact information



Primary contact

Dr Helen Bosomworth


Contact details

Stroke Research Group
3-4 Claremont Terrace
Newcastle University
Newcastle Upon Tyne
United Kingdom
+44 (0)191 2226322

Additional identifiers

EudraCT number number

Protocol/serial number

15309; HTA 11/26/05

Study information

Scientific title

Robot Assisted Training for the Upper Limb after Stroke (RATULS): a randomised interventional phase III study



Study hypothesis

To determine whether robot-assisted training with the InMotion robotic gym system (In Motion commercial version) improves upper limb function post stroke.

Ethics approval

National Research Ethics Service Committee North East - Sunderland, 05/11/2013, ref: 13/NE/0274

Study design

Randomised interventional phase III study

Primary study design


Secondary study design

Randomised controlled trial

Trial setting


Trial type


Patient information sheet

Not available in web format, please use the contact details to request a patient information sheet


Stroke rehabilitation


This is a three-group randomised controlled trial.

Group 1: Robot-assisted training
Robot-assisted training will use the InMotion robotic gym system which comprises three modules to exercise the shoulder/elbow, wrist and hand. Treatment will be provided for 45 minutes, 3 times per week for 12 weeks.

Group 2: Enhanced upper limb therapy
Enhanced upper limb therapy will consist of upper limb rehabilitation goal setting followed by practice of everyday activities to work towards the goals. Treatment will be provided for 45 minutes, 3 times per week for 12 weeks

Group 3: Usual NHS rehabilitation
This group will continue with usual NHS rehabilitation in accordance with local clinical practice.

Intervention type



Phase III

Drug names

Primary outcome measure

Upper limb function measured using the Action Research Arm Test (ARAT) at 3 months post randomisation

Secondary outcome measures

1. Upper limb impairment, measured using the Fugl-Meyer Test (motor and sensory arm sections)
2. Activities of daily living (measured using the Barthel ADL Index), quality of life (measured using EQ-5D-5L)
3. Upper limb pain, measured using a numerical rating scale
4. Resource use, measured using an adaption of the Client Services Receipt Inventory
5. Adverse events, measured at 3 and 6 months post randomisation

Overall trial start date


Overall trial end date


Reason abandoned (if study stopped)


Participant inclusion criteria

Adults with a first ever stroke who fulfil the following criteria are eligible:
1. Age 18 years and over
2. Clinical diagnosis of stroke (cerebral infarction, primary intracerebral haemorrhage, subarachnoid haemorrhage)
3. Between one week and five years since stroke
4. Moderate to severe upper limb functional limitation (Action Research Arm Test (ARAT) score 0-39) due to stroke
5. Able to provide consent to take part in the study and to comply with the requirements of the protocol

Participant type


Age group




Target number of participants

UK Sample Size: 720

Total final enrolment


Participant exclusion criteria

1. More than one stroke (patients with previous transient ischaemic attack (TIA) may be invited to participate)
2. Other current significant impairment of the upper limb affected by stroke e.g. fixed contracture, frozen shoulder, severe arthritis, recent fracture
3. Diagnosis likely to interfere with rehabilitation or outcome assessments e.g. registered blind
4. Previous use of the InMotion robotic gym system or other arm rehabilitation robot
5. Current participation in a rehabilitation trial evaluating upper limb rehabilitation after stroke
6. Previous enrolment in this study

Recruitment start date


Recruitment end date



Countries of recruitment

United Kingdom

Trial participating centre

Newcastle University
Newcastle Upon Tyne
United Kingdom

Sponsor information


Newcastle upon Tyne Hospitals NHS Foundation Trust (UK)

Sponsor details

Leazes Wing
Royal Victoria Infirmary
Queen Victoria Road
Newcastle Upon Tyne
United Kingdom

Sponsor type

Hospital/treatment centre



Funder type


Funder name

Health Technology Assessment Programme

Alternative name(s)

NIHR Health Technology Assessment Programme, HTA

Funding Body Type

government organisation

Funding Body Subtype

National government


United Kingdom

Results and Publications

Publication and dissemination plan

Not provided at time of registration

Intention to publish date


Participant level data

Not provided at time of registration

Basic results (scientific)

Publication list

2017 protocol in:
2019 results in: (added 29/05/2019)

Publication citations

Additional files

Editorial Notes

29/05/2019: The following changes were made to the trial record: 1. Publication reference added. 2. The total final enrolment was added. 16/01/2019: The intention to publish date has been changed from to 31/08/2020 15/01/2019: The overall trial end date was changed from 01/01/2018 to 31/08/2019. 25/07/2017: Publication reference added.