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

Objectives: To evaluate the effectiveness of overground 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.