The Effects of Robotic Training on Walking and Functional Independence of People with Spinal Cord Injury : A Systematic Review, Meta-analysis and Meta-regression

Abstract

Evidence on the effects of robotic technology is required to develop rehabilitation services. This study aimed to evaluate the effects of robot-assisted walking training on walking and functional independence in everyday life in persons with spinal cord injury (SCI) and explore the covariates associated with these effects.

We searched the MEDLINE (Ovid), CINAHL, PsycINFO, and ERIC databases until March 25, 2022. Two reviewers independently assessed the studies for inclusion. We included RCTs on people with SCI receiving robotic training. The Cochrane RoB2, meta-analysis, meta-regression, and Grading of Recommendations Assessment, Development, and Evaluation were performed.

We included 23 RCTs focusing on SCI with outcomes of walking or functional independence, of which 14 were included in the meta-analysis and meta-regression analyses. Small improvements were observed in functional independence in favor of robot-assisted walking training compared to other physical exercises (Hedges’ g 0.31, 95% CI 0.02 to 0.59; I2 = 19.7%, 9 studies, 419 participants, low certainty evidence). There were no significant differences in walking ability, speed, endurance, or independence between the groups.

Robot-assisted walking training may slightly improve functional independence, but its effects on walking ability in SCI patients is uncertain compared to other exercise. Evidence suggests little to no difference in walking independence, and the effects on walking speed and endurance are unclear. No clear evidence exists whether positive effects are linked to personal, clinical, or intervention characteristics. Robot-assisted gait training may be a viable option for improving functional independence in individuals with SCI.