Effect of assist-as-needed robotic gait training on the gait pattern post stroke: a randomized controlled trial.
J F Alingh, B M Fleerkotte, B E Groen and 5 others
PMID 33546733WHAT IT FOUND
After six weeks in inpatient stroke rehabilitation, adding assist-as-needed robotic gait training to conventional therapy did not improve the main measure of walking smoothness more than conventional therapy.
Both groups walked faster and had similar recovery.
Key findings
01Robotic gait training plus conventional gait training did not beat conventional gait training on the main walking-smoothness outcome.
02Most secondary outcomes improved over time; the only significant group differences were step width immediately after training and paretic step length at four months.
03In the 12 participants with a foot-clearance goal, peak knee flexion favoured robotic gait training plus conventional gait training at four months (p = 0.016), but not immediately after training (p = 0.055).
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study analysed 32 people, fewer than the 50 planned. It may not have been powerful enough to detect a small difference. Recruitment stopped after funding ended, and only 7.5% of people assessed for eligibility were randomised. The sample was small and selective. Participants had to be able to walk with at least some support and do the gait analysis independently. The results do not apply to stroke survivors who cannot walk without assistance. The robotic group received 19% more training sessions than the conventional group, and the robotic group also received conventional therapy. The effect of the robot alone cannot be separated from the extra therapy or the combined programme. The main measure was calculated from motion capture rather than force plates. The foot-clearance subgroup analysis was very small. Those findings need confirmation.
Declared interests
The paper reports funding from ZonMw and Hersenstichting (NL). It does not report author conflicts of interest, nor does it say the funders designed or wrote the study.
The easy way to misread this
Do not treat the foot-clearance subgroup finding as proof that robotic training improves knee flexion in routine practice. It was based on 12 participants. It was not significant immediately after training. The robotic group also received conventional therapy. The robot alone cannot be separated.