Effects of robot-assisted gait training on cardiopulmonary function and lower extremity strength in individuals with spinal cord injury: A systematic review and meta-analysis

Abstract

Context

Robot-assisted gait training (RAGT) has been increasingly adopted in many rehabilitation facilities for walking function and activity in individuals with spinal cord injury (SCI). However, the effectiveness of RAGT on lower extremity strength and cardiopulmonary function, especially static pulmonary function, have not been clearly outlined.

Objective

Determine the effect of RAGT on cardiopulmonary function and lower extremity strength in SCI survivors.

Methods

Eight databases were systematically searched for randomized controlled trials comparing RAGT with conventional physical therapy or other non-robotic therapies for survivors with SCI. Study selection required lower extremity strength decline after SCI at baseline. The overall effects of RAGT were calculated using a meta-analytic method. Begg’s test was used to assess the risk of publication bias.

Results

The pooled analysis demonstrated that RAGT may have a positive effect for individuals with SCI on lower extremity strength enhancing (n = 408; standardized mean difference [SMD]  =  0.81; 95% confidence interval [CI] = 0.14–1.48) and cardiopulmonary endurance(n = 104; standardized mean difference [SMD]  =  2.24; 95% confidence interval [CI] = 0.28–4.19). However, no significant effect was established on static pulmonary function. No publication bias was observed according to the Begg’s test.

Conclusions

RAGT may be a useful technique for improving lower limb strength and cardiovascular endurance in SCI survivors. The usefulness of RAGT in enhancing static pulmonary function was not demonstrated by the study. However, these results should be interpreted with caution, given the low number of selected studies and subjects. Clinical studies with large sample sizes will be necessary in the future.

Keywords:

• Spinal cord injury
• Robotic-assisted gait training
• Cardiopulmonary
• Static pulmonary
• Function
• Lower extremity strength
• Meta-analysis

Disclaimer statements

Contributors CW, SH and XW were involved in the study selection, data extraction and manuscript writing. PG, ZW and YZ performed the statistical analysis and participated in the data interpretation. BS and YL conceived the project and the study hypothesis, designed the study selection criteria, analyzed data. All authors read and approved the final manuscript. Chunli Wan, Xue Wang and Yuting Zhang are in training.

Funding This study was supported by the Major Scientific Research Project of Wuxi Health and Family Planning Commission [grant number Z202013], Wuxi Health and Family Planning Commission“Wuxi Taihu Talent Plan” [grant number WXTTP2020008], Jiangsu Provincial Commission of Health and Family Planning [grant number LR2021040] and Wuxi Municipal Bureau on Science and Technology.

Conflicts of interest Authors have no conflict of interests to declare.