Robot-Assisted Training for People With Spinal Cord Injury: A Meta-Analysis

Data Sources Randomized controlled trials (RCTs) or quasi-RCTs involving people with SCI that compared robot-assisted upper limbs or lower limbs training with a control of other treatment approach or no treatment. We included studies involving people with complete or incomplete SCIs. Study Selection We searched MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials (Cochrane Library), and Embase to August 2016. Bibliographies of relevant articles on the effect of body-weight–supported treadmill training on subjects with SCI were screened to avoid missing relevant articles from the search of databases. Data Extraction All kinds of objective assessments concerning physical ability, mobility, and/or functional ability were included. Assessments could be clinical tests (ie, 6-minute walk test, FIM) or laboratory tests (ie, gait analysis). Subjective outcome measures were excluded from this review. Data Synthesis Eleven RCT studies involving 443 subjects were included in the study. Meta-analysis was performed on the included studies. Walking independence (3.73; 95% confidence interval [CI], −4.92 to −2.53; P<.00001; I2=38%) and endurance (53.32m; 95% CI, −73.15 to −33.48; P<.00001; I2=0%) were found to have better improvement in robot-assisted training groups. Lower limb robot-assisted training was also found to be as effective as other types of body-weight–supported training. There is a lack of upper limb robot-assisted training studies; therefore, performing a meta-analysis was not possible. Conclusions Robot-assisted training is an adjunct therapy for physical and functional recovery for patients with SCI. Future high-quality studies are warranted to investigate the effects of robot-assisted training on functional and cardiopulmonary recovery of patients with SCI.