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Meta-Analysis
. 2020 Oct 22;10(10):CD006185.
doi: 10.1002/14651858.CD006185.pub5.

Electromechanical-assisted training for walking after stroke

Jan Mehrholz  1 , Simone Thomas  2 , Joachim Kugler  1 , Marcus Pohl  3 , Bernhard Elsner  1
Affiliations
Meta-Analysis

Electromechanical-assisted training for walking after stroke

Jan Mehrholz et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Electromechanical- and robot-assisted gait-training devices are used in rehabilitation and might help to improve walking after stroke. This is an update of a Cochrane Review first published in 2007 and previously updated in 2017.

Objectives: Primary • To determine whether electromechanical- and robot-assisted gait training versus normal care improves walking after stroke Secondary • To determine whether electromechanical- and robot-assisted gait training versus normal care after stroke improves walking velocity, walking capacity, acceptability, and death from all causes until the end of the intervention phase SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (last searched 6 January 2020); the Cochrane Central Register of Controlled Trials (CENTRAL; 2020 Issue 1), in the Cochrane Library; MEDLINE in Ovid (1950 to 6 January 2020); Embase (1980 to 6 January 2020); the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 20 November 2019); the Allied and Complementary Medicine Database (AMED; 1985 to 6 January 2020); Web of Science (1899 to 7 January 2020); SPORTDiscus (1949 to 6 January 2020); the Physiotherapy Evidence Database (PEDro; searched 7 January 2020); and the engineering databases COMPENDEX (1972 to 16 January 2020) and Inspec (1969 to 6 January 2020). We handsearched relevant conference proceedings, searched trials and research registers, checked reference lists, and contacted trial authors in an effort to identify further published, unpublished, and ongoing trials.

Selection criteria: We included all randomised controlled trials and randomised controlled cross-over trials in people over the age of 18 years diagnosed with stroke of any severity, at any stage, in any setting, evaluating electromechanical- and robot-assisted gait training versus normal care.

Data collection and analysis: Two review authors independently selected trials for inclusion, assessed methodological quality and risk of bias, and extracted data. We assessed the quality of evidence using the GRADE approach. The primary outcome was the proportion of participants walking independently at follow-up.

Main results: We included in this review update 62 trials involving 2440 participants. Electromechanical-assisted gait training in combination with physiotherapy increased the odds of participants becoming independent in walking (odds ratio (random effects) 2.01, 95% confidence interval (CI) 1.51 to 2.69; 38 studies, 1567 participants; P < 0.00001; I² = 0%; high-quality evidence) and increased mean walking velocity (mean difference (MD) 0.06 m/s, 95% CI 0.02 to 0.10; 42 studies, 1600 participants; P = 0.004; I² = 60%; low-quality evidence) but did not improve mean walking capacity (MD 10.9 metres walked in 6 minutes, 95% CI -5.7 to 27.4; 24 studies, 983 participants; P = 0.2; I² = 42%; moderate-quality evidence). Electromechanical-assisted gait training did not increase the risk of loss to the study during intervention nor the risk of death from all causes. Results must be interpreted with caution because (1) some trials investigated people who were independent in walking at the start of the study, (2) we found variation between trials with respect to devices used and duration and frequency of treatment, and (3) some trials included devices with functional electrical stimulation. Post hoc analysis showed that people who are non-ambulatory at the start of the intervention may benefit but ambulatory people may not benefit from this type of training. Post hoc analysis showed no differences between the types of devices used in studies regarding ability to walk but revealed differences between devices in terms of walking velocity and capacity.

Authors' conclusions: People who receive electromechanical-assisted gait training in combination with physiotherapy after stroke are more likely to achieve independent walking than people who receive gait training without these devices. We concluded that eight patients need to be treated to prevent one dependency in walking. Specifically, people in the first three months after stroke and those who are not able to walk seem to benefit most from this type of intervention. The role of the type of device is still not clear. Further research should consist of large definitive pragmatic phase 3 trials undertaken to address specific questions about the most effective frequency and duration of electromechanical-assisted gait training, as well as how long any benefit may last. Future trials should consider time post stroke in their trial design.

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Conflict of interest statement

Jan Mehrholz: was co‐author of one included trial (Pohl 2007). Simone Thomas: none known. Joachim Kugler: none known. Marcus Pohl: was a co‐author of one included trial (Pohl 2007). Bernhard Elsner: none known.

These review authors (MP, JM) did not participate in quality assessment nor in extraction of data from these studies.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Funnel plot of comparison: 1 Electromechanical‐ and robot‐assisted gait training plus physiotherapy versus physiotherapy (or usual care), outcome: 1.1 Independent walking at end of intervention phase, all electromechanical devices used.
4
4
Funnel plot of comparison: 1 Electromechanical‐ and robot‐assisted gait training plus physiotherapy versus physiotherapy (or usual care), outcome: 1.3 Walking velocity (metres per second) at end of intervention phase.
1.1
1.1. Analysis
Comparison 1: Electromechanical‐ and robot‐assisted gait training plus physiotherapy versus physiotherapy (or usual care), Outcome 1: Independent walking at end of intervention phase, all electromechanical devices used (primary outcome)
1.2
1.2. Analysis
Comparison 1: Electromechanical‐ and robot‐assisted gait training plus physiotherapy versus physiotherapy (or usual care), Outcome 2: Independent walking at follow‐up after study end (primary outcome)
1.3
1.3. Analysis
Comparison 1: Electromechanical‐ and robot‐assisted gait training plus physiotherapy versus physiotherapy (or usual care), Outcome 3: Walking velocity (metres per second) at end of intervention phase
1.4
1.4. Analysis
Comparison 1: Electromechanical‐ and robot‐assisted gait training plus physiotherapy versus physiotherapy (or usual care), Outcome 4: Walking velocity (metres per second) at follow‐up
1.5
1.5. Analysis
Comparison 1: Electromechanical‐ and robot‐assisted gait training plus physiotherapy versus physiotherapy (or usual care), Outcome 5: Walking capacity (metres walked in 6 minutes) at end of intervention phase
1.6
1.6. Analysis
Comparison 1: Electromechanical‐ and robot‐assisted gait training plus physiotherapy versus physiotherapy (or usual care), Outcome 6: Walking capacity (metres walked in 6 minutes) at follow‐up
1.7
1.7. Analysis
Comparison 1: Electromechanical‐ and robot‐assisted gait training plus physiotherapy versus physiotherapy (or usual care), Outcome 7: Lost to study during intervention phase, dropouts
1.8
1.8. Analysis
Comparison 1: Electromechanical‐ and robot‐assisted gait training plus physiotherapy versus physiotherapy (or usual care), Outcome 8: Death from all causes until end of intervention phase
2.1
2.1. Analysis
Comparison 2: Planned sensitivity analysis by trial methods, Outcome 1: Regaining independent walking ability
3.1
3.1. Analysis
Comparison 3: Subgroup analysis comparing participants in acute and chronic phases of stroke, Outcome 1: Independent walking at end of intervention phase, all electromechanical devices used
4.1
4.1. Analysis
Comparison 4: Post hoc sensitivity analysis: ambulatory status at start of study, Outcome 1: Recovery of independent walking: ambulatory status at start of study
4.2
4.2. Analysis
Comparison 4: Post hoc sensitivity analysis: ambulatory status at start of study, Outcome 2: Walking velocity: ambulatory status at start of study
5.1
5.1. Analysis
Comparison 5: Post hoc sensitivity analysis: type of device, Outcome 1: Different devices for regaining walking ability
5.2
5.2. Analysis
Comparison 5: Post hoc sensitivity analysis: type of device, Outcome 2: Different devices for regaining walking speed
5.3
5.3. Analysis
Comparison 5: Post hoc sensitivity analysis: type of device, Outcome 3: Different devices for regaining walking capacity
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Kwon 2018 {published data only}
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Kyung 2008 {published and unpublished data}
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Lee 2019 {published data only}
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Ochi 2015 {published data only}
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Peurala 2009 {published and unpublished data}
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    1. Waldman G, Yang C-Y, Ren Y, Liu L, Guo X, Harvey RL, et al. Effects of robot-guided passive stretching and active movement training of ankle and mobility impairments in stroke. NeuroRehabilitation 2013;32(3):625-34. - PubMed
Watanabe 2014 {published data only}
    1. JPRN-UMIN000022335. Effects of rehabilitation using the hybrid assistive limb in stroke patients. www.who.int/trialsearch/Trial2.aspx?TrialID=JPRN-UMIN000022335; 2016.
    1. Watanabe H, Tanaka N, Inuta T, Saitou H, Yanagi H. Locomotion improvement using a hybrid assistive limb in recovery phase stroke patients: a randomized controlled pilot study. Archives of Physical Medicine and Rehabilitation 2014;95(11):2006-12. [0003: 9993] - PubMed
Werner 2002 {published data only}
    1. Werner C, Von Frankenberg S, Treig T, Konrad M, Hesse S. Treadmill training with partial body weight support and an electromechanical gait trainer for restoration of gait in subacute stroke patients: a randomized crossover study. Stroke 2002;33(12):2895-901. - PubMed
Westlake 2009 {published data only}
    1. Westlake K, Patten C. Pilot study of Lokomat versus manual-assisted treadmill training for locomotor recovery post-stroke. Journal of NeuroEngineering and Rehabilitation 2009;6:18. [DOI: 10.1186/1743-0003-6-18] - DOI - PMC - PubMed
Yeung 2018 {published data only}
    1. NCT03184259. Interactive exoskeleton robot for walking. https://clinicaltrials.gov/ct2/show/record/NCT03184259; 2017.
    1. Yeung L-F, Ockenfeld C, Pang M-K, Wai H-W, Soo O-Y, Li S-W, et al. Randomized controlled trial of robot-assisted gait training with dorsiflexion assistance on chronic stroke patients wearing ankle-foot-orthosis. Journal of NeuroEngineering and Rehabilitation 2018;15(1):51. [1743-0003] - PMC - PubMed
Yun 2018 {published data only}
    1. Yun N, Joo MC, Kim SC, Kim MS. Robot-assisted gait training effectively improved lateropulsion in subacute stroke patients: a single-blinded randomized controlled trial. European Journal of Physical and Rehabilitation Medicine 2018;54(6):827-36. - PubMed

References to studies excluded from this review

Bae 2014 {published data only}
    1. Bae Y, Ko Y, Chang W, Lee J, Lee K, Park Y, et al. Effects of robot-assisted gait training combined with functional electrical stimulation on recovery of locomotor mobility in chronic stroke patients: a randomized controlled trial. Journal of Physical Therapy Science 2014;26(12):1949-53. [0915: 5287] - PMC - PubMed
Bergmann 2018a {published data only}
    1. Bergmann J, Krewer C, Bauer P, Koenig A, Riener R, Muller F. Virtual reality to augment robot-assisted gait training in non-ambulatory patients with a subacute stroke: a pilot randomized controlled trial. European Journal of Physical and Rehabilitation Medicine 2018;54(3):397-407. - PubMed
Jin 2018 {published data only}
    1. Jin Seok S, Hee Seung Y, Suk J, Chang Soon K, Sunghun J, Dae Hyun K, et al. Effect of reducing assistance during robot-assisted gait training on step length asymmetry in patients with hemiplegic stroke: a randomized controlled pilot trial. Medicine 2018;97(33):1-6. [0025-7974] - PMC - PubMed
Kang 2018 {published data only}
    1. Kang T-W, Oh D-W, Lee J-H, Cynn H-S. Effects of integrating rhythmic arm swing into robot-assisted walking in patients with subacute stroke: a randomized controlled pilot study. International Journal of Rehabilitation Research 2018;41(1):57-62. - PubMed
Kim 2019 {published data only}
    1. Kim H, Koo D, Yang S, Shin JH. Comparisons of exoskeleton and end-effector types of robot-assisted gait training in patients with stroke. Archives of Physical Medicine and Rehabilitation 2019;100(10):e58‐e59.
Koo 2019 {published data only}
    1. Koo D, Yang S, Shin J-H, Kim H. Comparisons of exoskeleton and end-effector types of robot-assisted gait training in patients with stroke. Archives of Physical Medicine & Rehabilitation 2019;100(10):e58-9. [0003-9993]
NCT01337960 {published data only}
    1. NCT01337960. Ankle robotics training after stroke. clinicaltrials.gov/show/NCT01337960 (first received 15 April 2011).
NCT03321097 {published data only}
    1. NCT03321097. A randomized controlled trial of distributed schedule of robot-assisted training after botulinum toxin injection in patient with spastic hemiplegic stroke: motor learning process and behavioral outcomes. https://clinicaltrials.gov/show/NCT03321097 (first received 27 January 2020).
NCT03991364 {published data only}
    1. NCT03991364. Comparison of robot-assisted gait training according to gait speed in participants with stroke. clinicaltrials.gov/ct2/show/NCT03991364 (first received 16 January 2020).
NCT04162197 {published data only}
    1. NCT04162197. Efficacy of end-effector robot-assisted gait training combined with robotic balance training in subacute stroke patients. clinicaltrials.gov/show/NCT04162197 (first received 28 January 2020).
Park 2015 {published data only}
    1. Park BS, Kim MY, Lee LK, Yang SM, Lee WD, Kim J. Effects of conventional overground gait training and a gait trainer with partial body weight support on spatiotemporal gait parameters of patients after stroke. Journal of Physical Therapy Science 2015;27:1603-7. - PMC - PubMed
Park 2019 {published data only}
    1. Park IJ, Park JH, Seong HY, You JH, Kim SJ, Min JH, et al. Comparative effects of different assistance force during robot-assisted gait training on locomotor functions in patients with subacute stroke: an assessor-blind, randomized controlled trial. American Journal of Physical Medicine & Rehabilitation 2019;98(1):58-64. [0894-9115] - PubMed
Picelli 2015 {published data only}
    1. Picelli A, Chemello E, Castellazzi P, Roncari L, Waldner A, Saltuari L, et al. Combined effects of transcranial direct current stimulation (tDCS) and transcutaneous spinal direct current stimulation (tsDCS) on robot-assisted gait training in patients with chronic stroke: a pilot, double blind, randomized controlled trial. Restorative Neurology & Neuroscience 2015;33(3):357-68. [1878-3627] - PubMed
Tamburella 2019 {published data only}
    1. Tamburella F, Moreno JC, Valenzuela DSH, Pisotta I, Iosa M, Cincotti F, et al. Influences of the biofeedback content on robotic post-stroke gait rehabilitation: electromyographic vs joint torque biofeedback. Journal of NeuroEngineering and Rehabilitation 2019;16. [1743-0003] - PMC - PubMed
Watanabe 2017 {published data only}
    1. JPRN-UMIN000022335. Effects of rehabilitation using the hybrid assistive limb in stroke patients. http://www.who.int/trialsearch/Trial2.aspx?TrialID=JPRN-UMIN000022335; 2016.
    1. Watanabe H, Goto R, Tanaka N, Matsumura A, Yanagi H. Effects of gait training using the Hybrid Assistive Limb® in recovery-phase stroke patients: a 2-month follow-up, randomized, controlled study. NeuroRehabilitation 2017;40(3):363‐7. - PubMed
    1. Watanabe H, Tanaka N, Goto R, Yanagi H. Effects of gait training with a Hybrid Assistive Limb® in stroke patients: a randomized controlled study with a 2-month follow-up. Archives of Physical Medicine & Rehabilitation 2016;97(10):e97.
Wu 2014 {published data only}
    1. Wu M, Landry J, Kim J, Schmit B, Yen S, MacDonald J. Robotic resistance/assistance training improves locomotor function in individuals poststroke: a randomized controlled study. Archives of Physical Medicine and Rehabilitation 2014;95(5):799-806. [0003: 9993] - PMC - PubMed

References to studies awaiting assessment

Calabro 2017 {published data only}
    1. Calabro RS, Naro A, Russo M, Balletta T, Buda A, Carioti L, et al. Motor recovery after stroke: the role of overground exoskeletons in shaping brain plasticity. European Journal of Neurology 2017;24:513.
Chernikova 2014 {published data only}
    1. Chernikova LA, Klochkov AS. The influence of physical training with the use of a Lokomat robotic system on the walking ability of the patients with post-stroke hemiparesis. Voprosy Kurortologii, Fizioterapii i Lechebnoi Fizicheskoi Kultury 2014;(3):13-7. [0042-8787] - PubMed
Faulkner 2018 {published data only}
    1. Faulkner J, Stone K, Fryer S, Wright A, Stoner L, Hobbs H, et al. The effect of robotic-assisted gait training on vascular and functional outcomes in patients with stroke. Cerebrovascular Diseases 2018;45 Suppl 1:42.
Globokar 2005 {published data only}
    1. Globokar D. Gait trainer in neurorehabilitation of patients after stroke. In: Battistella L, Imamura M, International Society of Physical and Rehabilitation Medicine , editors(s). 3rd World Congress of the International Society of Physical and Rehabilitation Medicine ISPRM; 2005 April 10-15; Sao Paulo, Brazil. Sao Paulo, Brazil, 2005:987-1.
Golyk 2006 {published data only (unpublished sought but not used)}
    1. Golyk VA, Pivnyk AP, Ipatov AV. Constraint-induced movement therapy for walking improvement (comparison of two walking training machine modifications' efficacy) for stroke patients. European Journal of Neurology 2006;13 Suppl 2:263.
Jang 2005 {published data only}
    1. Jang SJ, Park SW, Kim ES, Wee HM, Kim YH. Electromechanical gait trainer for restoring gait in hemiparetic stroke patients. In: Battistella L, Imamura M, International Society of Physical and Rehabilitation Medicine , editors(s). 3rd World Congress of the International Society of Physical and Rehabilitation Medicine ISPRM; 2005 April 10-15; Sao Paulo, Brazil. Sao Paulo, Brazil, 2005:909-1.
Kim 2014 {published data only}
    1. Kim JH, Park HI, Jang CH, Lim YH. Effects of robot-assisted therapy on lower limb in geriatric patients with subacute stroke. European Geriatric Medicine 2014;5 Suppl 1:S174. [DOI: 10.1016/S1878-7649(14)70458-9] - DOI
Ohata 2015 {published data only}
    1. Ohata K, Tsuboyama T, Watanabe A, Takahashi H. Gait training using new robotics device for patients with hemiplegia after stroke: a randomized cross-over trial. Physiotherapy 2015;101:eS1123-4. [0031-9406]
Sale 2012 {published data only}
    1. NCT01678547. Robot walking rehabilitation in stroke patients. clinicaltrials.gov/show/NCT01678547 (date first received 31 August 2012). [NCT01678547]
Waldner 2016 {published data only}
    1. Waldner A, Geroin C, Smania N. Robot-assisted stair climbing training and conventional physiotherapy in chronic stroke patients. A preliminary comparison. Neurologie und Rehabilitation 2016;22:S25.
Wall 2018 {published data only}
    1. NCT02410915. A comparison between the exoskeleton hybrid assistive limb and conventional gait training early after stroke (HAL-RCT). https://clinicaltrials.gov/ct2/show/NCT02410915; 2017.
    1. Wall A, Vreede K, Borg J, Palmcrantz S. The hybrid assistive limb (HAL) exoskeleton for individualized, intensive training of gait during inpatient stroke rehabilitation: a prospective randomized open blinded end-point (PROBE) study. European Stroke Journal 2018;3 Suppl 1:127.
Wright 2018a {published data only}
    1. Wright A, Jobson S, Smith G, Faulkner J. Effect of robotic-assisted gait training on the stance and swing phase of overground walking in patients with stroke. Cerebrovascular Diseases 2018;45:367.
Wu 2012 {published data only}
    1. Wu H, Gu XD, Fu JM, Yao YH, Li JH, Xu ZS. Effects of rehabilitation robot for lower-limb on motor function in hemiplegic patients after stroke. National Medical Journal of China 2012;37:2628-31. - PubMed
Yadav 2018 {published data only}
    1. Yadav R. Robotic assisted gait training (RAGT) for long term rehabilitation of stroke patients. Neurorehabilitation and Neural Repair 2018;32(4‐5):357.
Yoon 2015 {published data only}
    1. Yoon Y, Seok TY, Yu K, Lee KJ, Kang SK, Yun SB. Gait training with the newly developed active-assistive system for gait is feasible for hemiplegic patients after stroke. PM&R 2015;1:S115-6. [193-4148]

References to ongoing studies

ChiCTR1800018072 {published data only}
    1. ChiCTR1800018072. Investigation on robot-assisted rehabilitation training and brain reorganization mechanism in lower limb paralysis following stroke. http://www.who.int/trialsearch/Trial2.aspx?TrialID=ChiCTR1800018072 (first received 28 January 2020).
ISRCTN15088682 {published data only}
    1. ISRCTN15088682. Using the robotic gait training system (RGTS) to improve mobility functions for stroke patients. www.who.int/trialsearch/Trial2.aspx?TrialID=ISRCTN15088682 (first received 27 January 2020).
JPRN‐jRCTs042180078 {published data only}
    1. JPRN-jRCTs042180078. Randomized control study of effectiveness of Welwalk WW-1000. www.who.int/trialsearch/Trial2.aspx?TrialID=JPRN-jRCTs042180078 (first received 28 January 2020).
JPRN‐jRCTs052180129 {published data only}
    1. JPRN-jRCTs052180129. Pilot study of gait training with robot in acute hemiplegic patients. jrct.niph.go.jp/latest-detail/jRCTs052180129 (first received 16 January 2020).
JPRN‐jRCTs052180228 {published data only}
    1. JPRN-jRCTs052180228. Effects of gait exercise assist robot. jrct.niph.go.jp/latest-detail/jRCTs052180228 (first received 16 January 2020).
JPRN‐jRCTs062180099 {published data only}
    1. JPRN-jRCTs062180099. The effects of a walking assistant robot "RE-Gait". jrct.niph.go.jp/latest-detail/jRCTs062180099 (first received 16 January 2020).
JPRN‐jRCTs072180071 {published data only}
    1. JPRN-jRCTs072180071. Clinical application of Gait Exercise Assist Robot to one leg paralysis patients. www.who.int/trialsearch/Trial2.aspx?TrialID=JPRN-jRCTs072180071 (first received 28 January 2020).
JPRN‐UMIN000024805 {published data only}
    1. JPRN-UMIN000024805. Randomized controlled trial to prove the improvement efficacy of the walking program using the wearable assistive robot HAL for the patients with hemiparesis due to stroke. http://www.who.int/trialsearch/Trial2.aspx?TrialID=JPRN-UMIN000024805 (first received 27 January 2020).
JPRN‐UMIN000025129 {published data only}
    1. JPRN-UMIN000025129. Effects of Balance Exercise Assist Robot (BEAR) on balance in patients with hemiparetic stroke: a randomized controlled trial. www.who.int/trialsearch/Trial2.aspx?TrialID=JPRN-UMIN000025129 (first received 27 January 2020).
JPRN‐UMIN000025354 {published data only}
    1. JPRN-UMIN000025354. Evaluation of rehabilitation intervention using robotics knee orthosis. www.who.int/trialsearch/Trial2.aspx?TrialID=JPRN-UMIN000025354 (first received 27 January 2020).
JPRN‐UMIN000028042 {published data only}
    1. JPRN-UMIN000028042. Effects of gait exercise assist robot (GEAR) on the subjects with chronic stroke. upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000032108 (first received 16 January 2020).
JPRN‐UMIN000028559 {published data only}
    1. JPRN-UMIN000028559. Examination about the clinical response of a walk assistance robot, the walk exercise assist for the stroke one side lower limbs paralytic. upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000030445 (first received 16 January 2020).
JPRN‐UMIN000028587 {published data only}
    1. JPRN-UMIN000028587. The effects of using a walking assistant robot "RE-Gait". http://www.who.int/trialsearch/Trial2.aspx?TrialID=JPRN-UMIN000028587 (first received 16 January 2020).
JPRN‐UMIN000031194 {published data only}
    1. JPRN-UMIN000031194. The effects of gait training using an ankle-foot orthosis with a modular exoskeletal robot actuated by pneumatic artificial muscles. upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000035611 (first received 15 January 2020).
JPRN‐UMIN000031959 {published data only}
    1. JPRN-UMIN000031959. Randomized control study of effectiveness of Welwalk WW-1000 for convalescent stroke hemiplegic patients. http://www.who.int/trialsearch/Trial2.aspx?TrialID=JPRN-UMIN000031959 (first received 28 January 2020).
JPRN‐UMIN000034237 {published data only}
    1. JPRN-UMIN000034237. Rehabilitation trial using robotic wear curara(R) for patients with cerebrovascular and neurodegenerative diseases. Part 1: cerebrovascular disease. www.who.int/trialsearch/Trial2.aspx?TrialID=JPRN-UMIN000034237 (first received 28 January 2020).
KCT0001837 {published data only}
    1. KCT0001837. Robot-assisted walking training for patients with subacute stroke. www.who.int/trialsearch/Trial2.aspx?TrialID=KCT0001837 (first received 27 January 2020).
KCT0003090 {published data only}
    1. KCT0003090. The effect of end-effector type rehabilitation robot (Morning-Walk) training for stroke patients. cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=11942 (first received 28 January 2020).
Louie 2015 {published data only}
    1. Louie DR, Eng JJ, Mortenson WB, Yao J. Use of a powered robotic exoskeleton to promote walking recovery after stroke: study protocol for a randomized controlled trial. In: World Stroke Organization , editors(s). International Journal of Stroke. Vol. 10 Suppl 4. 2015:89. [onlinelibrary.wiley.com/doi/10.1111/ijs.12633_2/pdf]
Louie 2020 {published data only}
    1. Louie DR, Mortenson WB, Durocher M, Teasell R, Yao J, Eng JJ. Exoskeleton for post-stroke recovery of ambulation (ExStRA): study protocol for a mixed-methods study investigating the efficacy and acceptance of an exoskeleton-based physical therapy program during stroke inpatient rehabilitation. BMC Neurology 2020;20(1):35. [DOI: 10.1186/s12883-020-1617-7] - DOI - PMC - PubMed
    1. NCT02995265. Exoskeleton for post-stroke recovery of ambulation. clinicaltrials.gov/ct2/show/NCT02995265 (first received 27 January 2020).
NCT00284115 {unpublished data only}
    1. NCT00284115. Efficacy of a mechanical gait repetitive training technique in hemiparetic stroke patients. www.clinicaltrials.gov (first received 08 August 2016).
NCT00530543 {published data only}
    1. NCT00530543. Effects of gait training with assistance of a robot-driven gait orthosis in hemiparetic patients after stroke. www.clinicaltrials.gov (first received 2 September 2016).
NCT01146587 {published data only}
    1. NCT01146587. Robot assisted therapy for acute stroke patients: a comparative study of GangTrainer GT I, Lokomat system and conventional physiotherapy. www.clinicaltrials.gov (first received 2 September 2016).
NCT01187277 {published data only}
    1. Chanubol R, Wongphaet P, Werner C, Chavanich N, Panichareon L. Gait rehabilitation in subacute hemiparetic stroke: robot-assisted gait training versus conventional physical therapy. Journal of the Neurological Sciences 2013;333 Suppl 1:e574.
    1. NCT01187277. Robotic versus conventional training on hemiplegic gait. www.clinicaltrials.gov (first received 2 September 2016).
NCT01678547 {published data only}
    1. NCT01678547. Effect of robot assisted treatment on gait performance in stroke patients. www.ClinicalTrials.gov/show/NCT01678547 (first received 12 December 2012).
NCT01726998 {published data only}
    1. NCT01726998. Effects of locomotion training with assistance of a robot-driven gait orthosis in hemiparetic patients after subacute stroke. www.ClinicalTrials.gov/show/NCT01726998 (first received 2 September 2016).
NCT02114450 {published data only}
    1. NCT02114450. Human-machine system for the H2 lower limb exoskeleton. www.ClinicalTrials.gov/show/NCT02114450 (first received 2 September 2016).
NCT02471248 {published data only}
    1. NCT02471248. Interactive exoskeleton robot for walking - ankle joint. www.ClinicalTrials.gov/show/NCT02471248 (first received 2 September 2016).
NCT02483676 {published data only}
    1. NCT02483676. Ankle robot to reduce foot-drop in stroke. www.ClinicalTrials.gov/show/NCT02483676 (first received 2 September 2016).
NCT02545088 {published data only}
    1. NCT02545088. New technology for individualised, intensive training of gait after stroke - study II (HAL-RCT-II). www.clinicaltrials.gov/ct2/show/NCT02545088 (first received 2 September 2016).
NCT02680691 {published data only}
    1. NCT02680691. Robot assisted gait training in patients with infratentorial stroke. www.ClinicalTrials.gov/show/NCT02680691 (first received 2 September 2016).
NCT02694302 {published data only}
    1. NCT02694302. Clinical trial of robot-assisted-gait-training (RAGT) in stroke patients. www.ClinicalTrials.gov/show/NCT02694302 (first received 2 September 2016).
NCT02755415 {published data only}
    1. NCT02755415. Clinical applicability of robot-assisted gait training system in acute stroke patients. www.ClinicalTrials.gov/show/NCT02755415 (first received 2 September 2016).
NCT02759627 {published data only}
    1. NCT02759627. Does isolated robotic-assisted gait training improve functional status, daily living and quality of life in stroke? www.clinicaltrials.gov/show/NCT02759627 (first received 27 January 2020).
NCT02781831 {published data only}
    1. NCT02781831. Robot-assisted gait training for patients with stroke. www.ClinicalTrials.gov/show/NCT02781831 (first received 2 September 2016).
NCT02843828 {published data only}
    1. NCT02843828. Gait pattern analysis and feasibility of gait training with a walking assist robot in stroke patients and elderly adults. www.ClinicalTrials.gov/show/NCT02843828 (first received 2 September 2016).
NCT03104127 {published data only}
    1. NCT03104127. Effect of using a lower limb robotic device for patients with chronic stroke. www.clinicaltrials.gov/show/NCT03104127 (first received 27 January 2020).
NCT03264235 {published data only}
    1. NCT03264235. The effect of powered-knee exoskeleton assist on stair climbing in acute CVA. www.clinicaltrials.gov/ct2/show/NCT03264235 (first received 28 January 2020).
NCT03264261 {published data only}
    1. NCT03264261. Constraint induced movement therapy for walking in individuals post stroke. www.clinicaltrials.gov/ct2/show/NCT03264261 (first received 15 January 2020).
NCT03395717 {published data only}
    1. NCT03395717. Stroke rehabilitation with exoskeleton-assisted gait. www.clinicaltrials.gov/show/NCT03395717 (first received 28 January 2020).
NCT03444688 {published data only}
    1. NCT03444688. Development and evaluation of a novel portable robotic gait rehabilitation in chronic stroke. www.clinicaltrials.gov/ct2/show/NCT03444688 (first received 16 January 2020).
NCT03463746 {published data only}
    1. NCT03463746. Integrated, practice-oriented electromechanical-assisted gait training in subacute stroke patients. www.clinicaltrials.gov/ct2/show/NCT03463746 (first received 16 January 2020).
NCT03554642 {published data only}
    1. NCT03554642. Walkbot robotic training for improvement in gait. www.clinicaltrials.gov/show/NCT03554642 (first received 28 January 2020).
NCT03565185 {published data only}
    1. NCT03565185. Comparison of two different type robot assisted gait training In rehabilitation of stroke. www.clinicaltrials.gov/ct2/show/NCT03565185 (first received 16 January 2020).
NCT03659266 {published data only}
    1. NCT03659266. Effects of combined treatment by botulinum toxin and Lokomat® on walking ability in chronic stroke. www.clinicaltrials.gov/ct2/show/NCT03659266 (first received 15 January 2020).
NCT03686280 {published data only}
    1. NCT03686280. Resume walking by an interactive mobile robot of rehabilitation after vascular stroke (cerebral vascular stroke) in combination with traditional reeducation (ROBOK2). www.clinicaltrials.gov/ct2/show/NCT03686280 (first received 15 January 2020).
NCT03688165 {published data only}
    1. NCT03688165. The effects of gait rehabilitation after stroke by treadmill-based robotics versus traditional gait training. www.clinicaltrials.gov/show/NCT03688165 (first received 28 January 2020).
NCT03709329 {published data only}
    1. NCT03709329. Effects of end-effector type robot assisted gait therapy on gait pattern and energy consumption in chronic post-stroke hemiplegic patients. www.clinicaltrials.gov/show/NCT03709329 (first received 28 January 2020).
NCT03727919 {published data only}
    1. NCT03727919. Exoskeleton-assisted training to accelerate walking recovery early after stroke. www.clinicaltrials.gov/ct2/show/NCT03727919 (first received 16 January 2020).
NCT03817385 {published data only}
    1. NCT03817385. rTMS and robotic gait training in patients with stroke. www.clinicaltrials.gov/show/NCT03817385 (first received 28 January 2020).
NCT03980457 {published data only}
    1. NCT03980457. Effects of exoskeleton-assisted gait training on functional rehabilitation outcomes in patients with stroke. www.clinicaltrials.gov/show/NCT03980457 (first received 28 January 2020).
NCT04033185 {published data only}
    1. NCT04033185. To investigate the effects of robotic-assisted gait training in stroke patients. www.clinicaltrials.gov/show/NCT04033185 (first received 16 January 2020).
NCT04054739 {published data only}
    1. NCT04054739. Cortical activity and gait function for robotic gait training in hemiparetic stroke. www.clinicaltrials.gov/ct2/show/NCT04054739 (first received 28 January 2020).
TCTR20180419004 {published data only}
    1. TCTR20180419004. Effect of the robotic-assisted gait training device (Welwalk®) plus physiotherapy in improving the ambulatory function in sub-acute hemiplegic stroke patients: investigator- blinded, randomized controlled trial. apps.who.int/trialsearch/Trial2.aspx?TrialID=TCTR20180419004 (first received 16 January 2020).
Wright 2018 {published data only}
    1. Wright A, Stone K, Lambrick D, Fryer S, Stoner L, Tasker E, et al. A community-based, bionic leg rehabilitation program for patients with chronic stroke: clinical trial protocol. Journal of Stroke and Cerebrovascular Diseases 2018;27(2):372-80. - PubMed

Additional references

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References to other published versions of this review

Mehrholz 2006
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Mehrholz 2007
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Mehrholz 2013
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Mehrholz 2017
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