Clinical utility of the over-ground bodyweight-supporting walking system Andago in children and youths with gait impairments.

Only 18 participants provided usable data, so the study cannot show how the device works for a wider range of children with severe gait impairment. The sample was heterogeneous, including cerebral palsy, brain injury, tumour, polyneuropathy, Guillain-Barré, ataxia, osteosarcoma, Charcot-Marie-Tooth syndrome and others, so results may not apply to one diagnosis. The study tested practicability, acceptability and gait pattern differences, not clinical effectiveness, and the authors state effectiveness has not been shown. There was no control group or comparison with another over-ground bodyweight support device, so usability findings are not benchmarked. The order of Andago and treadmill conditions could not be randomised because treadmill speed was set to the Andago speed, and participants may have walked on the treadmill at slightly higher than preferred speeds. Some acceptability questions were not validated, and GMFCS and SCALE were used outside their usual cerebral palsy population. Many participants had relatively good walking ability, partly because the device requires patients to initiate and perform leg movements, limiting generalisation to children who need guided leg movement. Bodyweight unloading levels were individualised, with reference unloading ranging from 6 to 42% of bodyweight, so comparisons across participants and to other studies are difficult. Muscle activity data were incomplete for some participants because orthoses prevented electrode placement or signals were poor. Accessibility and cost-effectiveness were not investigated.

Do not conclude that Andago improves walking or is better than treadmill training for function. This was a clinical utility study of 18 participants, and the authors state that effectiveness has not been shown.