Comparative efficacy of robotic exoskeleton and conventional gait training in patients with spinal cord injury: a meta-analysis of randomized controlled trials.

All 15 included trials had a risk of bias in participant and personnel blinding, which is expected in gait training but means patients and therapists knew who was getting the robot. Only 2 of the 15 trials qualified as Level-1 evidence; the rest were Level-2. GRADE rated the 6MWT evidence as Very Low and all other outcomes as Low. Training protocols varied widely: 3 to 20 weeks, 30 to 90 minutes per session, 2 to 5 days per week, and different combinations of robotic and conventional elements within the same session. Participants ranged from ASIA A (complete paralysis) to D, and the authors could not run a subgroup analysis by ASIA level because the included studies did not report enough data. Some trials had very small samples (as few as 4 participants in one arm), and one study had a 40% dropout rate. The Lokomat and exoskeleton groups were each compared to their own conventional therapy control, not directly against each other, so the device-type comparison is indirect. The respiratory function data come from only 2 studies with 34 patients total.

Funded by the 345 Talent Project of Shengjing Hospital and the Liaoning Province Science and Technology Plan Joint Program (Natural Science Foundation, General Project). No industry funding or conflicts of interest declared.

Do not read this as evidence that a robotic exoskeleton is a better gait intervention than the therapy you already deliver. The two outcomes patients care about most, walking speed and walking distance, showed no significant difference, and in the chronic-injury subgroup conventional therapy was significantly better for speed. The significant findings (balance, motor scores) are secondary outcomes, and the GRADE evidence is rated Low to Very Low across the board.