Effect of wearable exoskeleton on post-stroke gait: A systematic review and meta-analysis

• Published in: Annals of physical and rehabilitation medicine 2023-02, Vol.66 (1), p.101674-101674, Article 101674
• Main Authors: Hsu, Ting-Hsuan, Tsai, Chi-Lin, Chi, Ju-Yang, Hsu, Chih-Yang, Lin, Yen-Nung
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Exoskeleton Device; Gait; Humans; Mobility limitation; Robotics; Stroke; Stroke Rehabilitation; Walking; Wearable device; Wearable Electronic Devices
• ISSN: 1877-0657; 1877-0665
• DOI: 10.1016/j.rehab.2022.101674

•Exoskeleton-assisted and conventional gait training were compared (POWER-assisted gait training [PAGT] vs conventional gait training).•PAGT was superior in improving walk speed and balance at the end of the training.•PAGT was superior in improving overall mobility at the end of the follow-up.•Whether wearing exoskeleton is beneficial during walking remains unknown. Wearable exoskeletons are a recently developed technology. The present systematic review aimed to investigate the effect of a wearable exoskeleton on post-stroke walking by considering its use in a gait training system and simply as an orthosis assisting walking. We systematically searched for randomised and quasi-randomised controlled trials in PubMed, Scopus, CINAHL and Embase databases from their earliest publication record to July 2021. We chose reports of trials investigating the effects of exoskeleton-assisted training or the effects of wearing an exoskeleton to assist walking. A meta-analysis was conducted to explore the benefits of the wearable exoskeleton on mobility capacity, walking speed, motor function, balance, endurance and activities of daily living. We included 13 studies (492 participants) comparing exoskeleton-assisted training with dose-matched conventional gait training. Studies addressing the effect of wearing a wearable exoskeleton were unavailable. As compared with conventional gait training at the end of the intervention, exoskeleton-assisted training was superior for walking speed (mean difference [MD] 0.13 m/s, 95% CI 0.05; 0.21) and balance (standardized MD [SMD] 0.3, 95% CI 0.07; 0.54). The subgroup with chronic stroke (i.e., > 6 months) presented the outcome favouring exoskeleton-assisted training regarding overall mobility capacity (SMD 0.37, 95% CI 0.04; 0.69). At the end of follow-up, exoskeleton-assisted training was superior to conventional gait training in overall mobility (SMD 0.45, 95% CI 0.07; 0.84) and endurance (MD 46.23 m, 95% CI 9.90; 82.56). Exoskeleton-assisted training was superior to dose-matched conventional gait training in several gait-related outcomes at the end of the intervention and follow-up in this systematic review and meta-analysis, which may support the use of exoskeleton-assisted training in the rehabilitation setting. Whether wearing versus not wearing a wearable exoskeleton is beneficial during walking remains unknown.