Overground Robotic Exoskeleton Training for Patients With Stroke on Walking-Related Outcomes: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Abstract

Objective: This review aims to evaluate the effectiveness of solely overground robotic exoskeleton (RE) training or overground RE training with conventional rehabilitation in improving walking ability, speed, and endurance among patients with stroke.

Data sources: Nine databases, 5 trial registries, gray literature, specified journals, and reference lists from inception until December 27, 2021.

Study selection: Randomized controlled trials adopting overground robotic exoskeleton training for patients with any phases of stroke on walking-related outcomes were included.

Data extraction: Two independent reviewers extracted items and performed risk of bias using the Cochrane Risk of Bias tool 1 and certainty of evidence using the Grades of Recommendation Assessment, Development, and Evaluation.

Data synthesis: Twenty trials involving 758 participants across 11 countries were included in this review. The overall effect of overground robotic exoskeletons on walking ability at postintervention (d=0.21; 95% confidence interval [CI], 0.01, 0.42; Z=2.02; P=.04) and follow-up (d=0.37; 95% CI, 0.03, 0.71; Z=2.12; P=.03) and walking speed at postintervention (d=0.23; 95% CI, 0.01, 0.46; Z=2.01; P=.04) showed significant improvement compared with conventional rehabilitation. Subgroup analyses suggested that RE training should combine with conventional rehabilitation. A preferable gait training regime is <4 times per week over ≥6 weeks for ≤30 minutes per session among patients with chronic stroke and ambulatory status of independent walkers before training. Meta-regression did not identify any effect of the covariates on the treatment effect. The majority of randomized controlled trials had small sample sizes, and the certainty of the evidence was very low.

Conclusion: Overground RE training may have a beneficial effect on walking ability and walking speed to complement conventional rehabilitation. Further large-scale and long-term, high-quality trials are recommended to enhance the quality of overground RE training and confirm its sustainability.

Keywords: Rehabilitation; Robotic exoskeleton; Stroke; Walking.