Effect of exoskeleton robot-assisted training on gait function in chronic stroke survivors: a systematic review of randomised controlled trials

OBJECTIVES: Numbers of research have reported the usage of robot-assisted gait training for walking restoration post-stroke. However, no consistent conclusion has been reached yet about the efficacy of exoskeleton robot-assisted training (ERAT) on gait function of stroke survivors, especially during the chronic period. We conducted a systematic review to investigate the efficacy of ERAT on gait function for chronic stroke survivors. DESIGN: This review followed the Participant, Intervention, Comparison and Outcome principle. DATA SOURCES: PubMed, Cochrane Library, Web of Science, Embase and Cumulative Index to Nursing and Allied Health Literature databases were systematically searched until December 2022. ELIGIBILITY CRITERIA: Only randomised controlled trials (RCTs) were included and these RCTs took patients who had a chronic stroke as participants, exoskeleton robot-assisted gait training as intervention, regular rehabilitation therapy as comparison and gait-related functional assessments as outcomes. DATA EXTRACTION AND SYNTHESIS: Data extraction and synthesis used the reporting checklist for systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The risk of bias and methodological quality of included studies were evaluated by two independent investigators under the guidance of Cochrane risk of bias. RESULTS: Out of 278 studies, a total of 10 studies (n=323, mean age 57.6 years, 63.2% males) were identified in this systematic review. According to the Cochrane risk of bias, the quality of these studies was assessed as low risk. Six studies reported favourable effects of ERAT on gait function involving gait performance, balance function and physical endurance, and the ERAT group was significantly superior when compared with the control group. In contrast, the other four trials showed equal or negative effects of ERAT considering different study designs. All the included studies did not claim any serious adverse events. CONCLUSION: ERAT could be an efficient intervention to improve gait function for individuals who had a chronic stroke. However, more rigorously designed trials are required to draw more solid evidence. PROSPERO REGISTRATION NUMBER: CRD42023410796.