Ann Rehabil Med.  2024 Jun;48(3):171-191. 10.5535/arm.230039.

Robot-Assisted Gait Training in Individuals With Spinal Cord Injury: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

• Park JM
• Kim YW
• Lee SJ
• Shin JC

• KMID: 2557065
• DOI: http://doi.org/10.5535/arm.230039

Abstract

Spinal cord injury (SCI) rehabilitation emphasizes locomotion. Robotic-assisted gait training (RAGT) is widely used in clinical settings because of its benefits; however, its efficacy remains controversial. We conducted a systematic review and meta-analysis to investigate the efficacy of RAGT in patients with SCI. We searched international and domestic databases for articles published until April 18, 2024. The meta-analysis employed a random effects model to determine the effect size as either mean difference (MD) or standardized MD (SMD). Evidence quality was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Twenty-three studies with a total of 690 participants were included in the final analysis. The overall pooled effect size for improvement in activities of daily living was 0.24, with SMD (95% confidence interval [95% CI], 0.04–0.43; GRADE: high) favoring RAGT over conventional rehabilitation. Muscular strength (MD, 0.23; 95% CI, 0.02–0.44; GRADE: high), walking index for SCI (MD, 0.31; 95% CI, 0.07–0.55; GRADE: moderate) and 6 min walk test distance (MD, 0.38; 95% CI, 0.14–0.63; GRADE: moderate) showed significant improvement in the robot group. Subgroup analysis revealed that subacute patients and intervention periods >2 months were more effective. This meta-analysis revealed that RAGT significantly improved activities of daily living, muscular strength, and walking abilities. Additional studies are needed to identify the optimal treatment protocol and specific patient groups for which the protocol is most effective.

Keyword

Spinal cord injuries; Robotics; Locomotion; Gait; Recovery of function

Figure

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  Fig. 1. Screening and selecting studies using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart.

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  Fig. 2. Traffic light diagram for the risk of bias of included studies as assessed using the Cochrane Risk of Bias 2.0 tool.

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  Fig. 3. Meta-analysis of the effects of RAGT in patients with spinal cord injury (SCI). (A) Activities of daily living. (B) Muscular strength. (C) Spasticity. (D) Balance.

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  Fig. 4. Meta-analysis of the effects of RAGT on walking ability in patients with spinal cord injury (SCI). (A) Walking index for spinal cord injury (WISCI). (B) 10-min walk test (10MWT) Speed (m/s).

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  Fig. 5. Meta-analysis of the effects of the RAGT on walking ability in patients with spinal cord injury (SCI). (A) 6-min walk test (6MWT) Distance (m). (B) Step length (m).

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  Fig. 6. Meta-analysis of the effects of the RAGT in patients with spinal cord injury (SCI). (A) Body composition. (B) Cardiopulmonary function.

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