Comparative efficacy of robotic exoskeleton and conventional gait training in patients with spinal cord injury: a meta-analysis of randomized controlled trials

Abstract

Objective: The purpose of this meta-analysis was to investigate the effects of Robotic exoskeleton gait training (REGT) on lower limb mobility, walking balance, functional scores and respiratory function in patients with spinal cord injury (SCI).

Data sources: The PubMed, Embase, Cochrane Library databases were systematically searched from inception until December 24, 2024.

Study selection: Eligible randomized controlled trials contained information on the population (SCI), intervention (REGT), and outcomes (walking speed and distance, walking balance, functional scores for SCI rehabilitation, respiratory function). Participants in the REGT intervention group were compared with those in conventional physical gait training (CPT) groups. Two independent researchers conducted the research,screened the articles, and assessed their eligibility.

Data extraction: Two independent researchers extracted key information from each eligible study. The authors' names, year of publication, setting, total sample size, REGT, CPT training schedule, baseline/mean difference (MD), and 95% confidence interval (CI) were extracted using a standardized form, and the methodological quality was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system.

Data synthesis: Of 595 studies identified, 15 randomized controlled trials (n = 579) were included for meta-analysis. Compared with conventional physical gait training (CPT), REGT showed no significant efficacy in walking speed (10-Meter Walk Test, WMD (95%CI) = - 0.03 (- 0.06, 0.00) m/s, P = 0.08) and walking distance, (6-Minute Walk Test, WMD (95% CI) = -1.83 (- 14.48, 10.83) meters, P = 0.78). REGT showed statistically significant efficacy in walking stability (Timed Up and Go, WMD (95%CI) = 6.62 (0.35, 12.88) s, P = 0.04) and functional scores such as Walking Index for Spinal Cord Injury Version II (WMD (95%CI) = 2.17 (1.05, 3.29), P = 0.0001) and Lower Extremity Motor Score (WMD (95%CI) = 1.33 (0.58, 2.07), P = 0.0005). Additional Significant efficacy was also found in terms of respiratory function (forced expiratory volume in one second, WMD (95%CI) = 0.60 (0.05, 1.16) L, P = 0.03).

Conclusions: This meta-analysis discovered the evidence that robotic exoskeleton gait training can improve the walking balance, strength of lower limbs, functional scores and respiratory function in the patients with spinal cord injury (SCI) compared to conventional gait training (CPT). No obvious evidence showed that REGT has more advantages than CPT in improving walking speed and distance. REGT combined with CPT are more recommended in the discovery of walking speed and distance of patients above 6 months after SCI.

Keywords: Gait rehabilitation; Meta-analysis; Robotic exoskeleton gait training; Spinal cord injury.

Fig. 1

Flow chart showing the study selection process

Fig. 2

Risk of bias graph and summary

Fig. 3

Forest plots for REGT compared with CPT in walking speed assessing the 10 MWT (A), and walking distance using 6 MWT (B)

Fig. 4

Subgroup analysis of 10 MWT and 6 MWT. SCI patients were treated by REGT compared with CPT starting at the early stage or above 6 months after SCI assessing 10 MWT (A) and 6 MWT (B); utilizing different kind of robotic exoskeleton, Lokomat or exoskeleton assessing 10 MWT (C) and 6 MWT (D)

Fig. 5

Forest plots for REGT compared with CPT in walking stability assessing TUG (A) and functional scores using the WISCI-II (B) and LEMS (C)

Fig. 6

Subgroup analysis of WISCI-II and LEMS. SCI patients were treated by REGT compared with CPT starting at the early stage or 6 months after SCI assessing WISCI-II (A) and LEMS (B); utilizing different kind of robotic exoskeleton, Lokomat or exoskeleton assessing WISCI-II (C) and LEMS (D)

Fig. 7

Forest plots for REGT compared with CPT in respiratory function assessing the FVC (A), FEV1 (B) and PEF (C)