Effectiveness of over-ground robotic locomotor training in improving walking performance, cardiovascular demands, secondary complications and user-satisfaction in individuals with spinal cord injuries: A systematic review

Abstract

OBJECTIVES: To evaluate the effectiveness of over-ground robotic locomotor training in individuals with spinal cord injuries with regard to walking performance, cardiovascular demands, secondary health complications and user-satisfaction. DATA SOURCES: PubMed, Cochrane, Web of Science, Scopus, EBSCOhost and Engineering Village. STUDY SELECTION: Trials in which robotic locomotor training was used for a minimum of 3 participants with spinal cord injury. DATA EXTRACTION: Independent extraction of data by 2 reviewers using a pre-established data abstraction table. Quality of evidence assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). DATA SYNTHESIS: Total of 27 non-controlled studies representing 308 participants. Most studies showed decreases in exertion ratings, pain and spasticity and reported positive well-being post-intervention. Seven studies were included in meta-analyses on walking performance, showing significant improvements post-intervention (p < 0.05), with pooled effects for the 6-min walking test and 10-metre walking test of-0.94 (95% confidence interval (95% CI) -1.53,-0.36) and -1.22 (95% CI -1.87,-0.57), respectively. The Timed Up and Go Test showed a positive pooled effect of 0.74 (95% CI 0.36, 1.11). Improvements in walking parameters were seen with an increase in session number; however, no significant cardiovascular changes were found over time. CONCLUSION: Robotic locomotor training shows promise as a tool for improving neurological rehabilitation; however, there is limited evidence regarding its training benefits. Further high-powered, randomized controlled trials, with homogenous samples, are required to investigate these effects.