Effectiveness of robot-assisted gait training in persons with spinal cord injury: a systematic review.

OBJECTIVE To assess the quality of current evidence as to the effectiveness of robot-assisted gait training in spinal cord injured patients, focusing on walking ability and performance. METHODS A search was conducted in MEDLINE, Web of Knowledge, Cochrane Library, Physiotherapy Evidence Database (PEDro) and Digital Academic Repositories (DAREnet) (1990-2009). Key words included "spinal cord injury", "(robot-assisted) gait rehabilitation" and "driven gait orthosis". Articles were included when complete and incomplete adult spinal cord injured patients participated in robot-assisted gait training intervention studies. The methodological quality was rated independently by 2 researchers using "van Tulder criteria list" and "evaluation of quality of an intervention study". Descriptive analyses were performed using the Population Intervention Comparison Outcome (PICO) method. RESULTS Two randomized controlled trials (mean quality score: 11.5/19) and 4 pre-experimental trials (mean quality score: 24.25 (standard deviation; SD 0.28)/48) involving 43 patients with incomplete, acute or chronic lesions between C3 and L1 were analysed. Five studies used the Lokomat and one used the LokoHelp. Although some improvements were reported related to body functions and activities, there is insufficient evidence to draw firm conclusions, due to small samples sizes, methodological flaws and heterogeneity of training procedures. CONCLUSION There is currently no evidence that robot-assisted gait training improves walking function more than other locomotor training strategies. Well-designed randomized controlled trials are needed.