This study evaluated the effectiveness of robot-assisted therapy (RAT) compared to intensive comparison therapy (ICT) and usual care in patients with long-term upper-limb impairment after stroke. The study involved 127 patients with moderate-to-severe upper-limb impairment 6 months or more after a stroke. Patients were randomly assigned to receive either RAT (49 patients), ICT (50 patients), or usual care (28 patients). Therapy consisted of 36 one-hour sessions over 12 weeks. The primary outcome was a change in motor function, measured by the Fugl-Meyer Assessment of Sensorimotor Recovery after Stroke, at 12 weeks. Secondary outcomes included the Wolf Motor Function Test and the Stroke Impact Scale. At 12 weeks, RAT showed a slight improvement in motor function compared to usual care, but no significant difference was found compared to ICT. However, the Stroke Impact Scale showed significant improvement with RAT compared to usual care. Secondary analyses at 36 weeks showed that RAT significantly improved motor function and motor-task performance compared to usual care, but not compared to ICT. No serious adverse events were reported. The study found that RAT did not significantly improve motor function at 12 weeks compared to usual care or ICT. However, over the 36-week study period, RAT resulted in significant but modest improvements in motor capability and motor-task performance compared to usual care but not ICT. The study highlights the potential long-term benefits of intensive rehabilitation in patients with moderate-to-severe impairment even years after a stroke. The results suggest that high-intensity, repetitive, task-oriented movement training may be necessary for motor recovery. The study also notes that the effectiveness of rehabilitation may vary depending on the patient's baseline condition and the duration of impairment. The findings indicate that while RAT did not show significant improvement at 12 weeks, it may offer long-term benefits in motor function and quality of life for stroke survivors.This study evaluated the effectiveness of robot-assisted therapy (RAT) compared to intensive comparison therapy (ICT) and usual care in patients with long-term upper-limb impairment after stroke. The study involved 127 patients with moderate-to-severe upper-limb impairment 6 months or more after a stroke. Patients were randomly assigned to receive either RAT (49 patients), ICT (50 patients), or usual care (28 patients). Therapy consisted of 36 one-hour sessions over 12 weeks. The primary outcome was a change in motor function, measured by the Fugl-Meyer Assessment of Sensorimotor Recovery after Stroke, at 12 weeks. Secondary outcomes included the Wolf Motor Function Test and the Stroke Impact Scale. At 12 weeks, RAT showed a slight improvement in motor function compared to usual care, but no significant difference was found compared to ICT. However, the Stroke Impact Scale showed significant improvement with RAT compared to usual care. Secondary analyses at 36 weeks showed that RAT significantly improved motor function and motor-task performance compared to usual care, but not compared to ICT. No serious adverse events were reported. The study found that RAT did not significantly improve motor function at 12 weeks compared to usual care or ICT. However, over the 36-week study period, RAT resulted in significant but modest improvements in motor capability and motor-task performance compared to usual care but not ICT. The study highlights the potential long-term benefits of intensive rehabilitation in patients with moderate-to-severe impairment even years after a stroke. The results suggest that high-intensity, repetitive, task-oriented movement training may be necessary for motor recovery. The study also notes that the effectiveness of rehabilitation may vary depending on the patient's baseline condition and the duration of impairment. The findings indicate that while RAT did not show significant improvement at 12 weeks, it may offer long-term benefits in motor function and quality of life for stroke survivors.