Efficacy of robot-assisted gait training in multiple sclerosis: A systematic review and meta-analysis

Shu-Wei Yeh; Li-Fong Lin; Ka-Wai Tam; Ching-Piao Tsai; Chien-Hsiung Hong; Yi-Chun Kuan

doi:10.1016/j.msard.2020.102034

Efficacy of robot-assisted gait training in multiple sclerosis: A systematic review and meta-analysis

Mult Scler Relat Disord. 2020 Mar 3:41:102034. doi: 10.1016/j.msard.2020.102034. Online ahead of print.

Authors

Shu-Wei Yeh¹, Li-Fong Lin², Ka-Wai Tam³, Ching-Piao Tsai⁴, Chien-Hsiung Hong⁵, Yi-Chun Kuan⁶

Affiliations

¹ Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taoyuan City, Taiwan; School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
² Department of Physical Medicine and Rehabilitation, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan; Neuroscience Research Center, Taipei Medical University, Taiwan; Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taiwan.
³ Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Center for Evidence-Based Health Care, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan; Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of General Surgery, Department of Surgery, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
⁴ Department of Biotechnology, Asia University, Taichung, Taiwan; Beito Health Management Hospital, Taipei, Taiwan.
⁵ School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Internal Medicine, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan. Electronic address: b101100083@tmu.edu.tw.
⁶ Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Center for Evidence-Based Health Care, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan; Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan; Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address: yckuang2@gmail.com.

PMID: 32200337
DOI: 10.1016/j.msard.2020.102034

Abstract

Background: Multiple sclerosis is a progressive disease responsible for gait disabilities and cognitive impairment, which affect functional performance. Robot-assisted gait training is an emerging training method to facilitate body-weight-supported treadmill training in many neurologic diseases. Through this study, we aimed to determine the efficacy of robot-assisted gait training in patients with multiple sclerosis.

Methods: We performed a systematic review and meta-analysis of randomized controlled trials evaluating the effect of robot-assisted gait training for multiple sclerosis. We searched PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov registry for articles published before May 2019. The primary outcome was walking performance (gait parameters, balance, and ambulation capability). The secondary outcomes were changes in perceived fatigue, severity of spasticity, global mobility, physical and mental quality of life, severity of pain, activities of daily living, and treatment acceptance.

Results: We identified 10 studies (9 different trials) that included patients with multiple sclerosis undergoing robot-assisted gait training or conventional walk training. The meta-analysis showed comparable effectiveness between robot-assisted gait training and conventional walking therapy in walking performance, quality of life, pain, or activities of daily living. The robot-assisted gait training was even statistically superior to conventional walking therapy in improving perceived fatigue (pooled SMD: 0.34, 95% CI: 0.02-0.67), spasticity (pooled SMD: 0.70, 95% CI: 0.08-1.33, I² = 53%), and global mobility (borderline) after the intervention.

Conclusion: Our results provide the most up-to-date evidence regarding the robot-assisted gait training on multiple sclerosis. In addition to the safety and good tolerance, its efficacy on multiple sclerosis is comparable to that of conventional walking training and is even superior in improving fatigue and spasticity.

Keywords: Fatigue; Multiple sclerosis; Quality of life; Robot-assisted gait training; Walking performance.