A systematic review of the determinants of implementation of a locomotor training program using a powered exoskeleton for individuals with a spinal cord injury.
Caroline Charette, Julien Déry, Andreanne K Blanchette and 4 others
PMID 37036438WHAT IT FOUND
Implementation of exoskeleton gait training depends on managing expectations, securing staff time, and handling adverse events like falls or skin lesions.
High costs and device complexity are barriers, while perceived health benefits and reduced clinician strain are facilitators for adoption in clinical settings.
Key findings
01The most frequently cited barriers to implementation are device complexity, high purchase costs, and adverse events such as falls, fractures, and skin lesions.
02Successful integration requires clear, realistic objectives agreed with patients, as mismatched expectations regarding walking speed or independence are a common source of dissatisfaction.
03Clinicians need dedicated time for training and protocol development, and support from multidisciplinary teams to safely manage concurrent medical conditions and technical issues.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Data extraction was not performed by two independent reviewers, which may introduce bias. Determinants were not analyzed separately for different stakeholder groups (e.g., clinicians vs. patients), potentially masking conflicting perspectives. The methodological quality of the included studies was not assessed due to the variety of designs. The 'outer setting' and 'implementation process' domains were poorly documented in the literature, leaving gaps in understanding systemic and procedural barriers.
Declared interests
The authors declared no potential conflicts of interest. The study was supported by the Praxis Spinal Cord Institute and the Fonds de recherche du Québec – Santé.
The easy way to misread this
Do not interpret the high number of identified determinants as evidence that exoskeleton training is effective for walking recovery. This review synthesizes barriers and facilitators to *implementation*, not clinical outcomes of the intervention itself. The presence of facilitators does not guarantee efficacy, and the null or mixed results of the primary outcomes in the included studies are not reported here.