Effect of combined home-based, overground robotic-assisted gait training and usual physiotherapy on clinical functional outcomes in people with chronic stroke: A randomized controlled trial.
Amy Wright, Keeron Stone, Louis Martinelli and 6 others
PMID 33356519WHAT IT FOUND
Adding a home-based robotic leg orthosis to usual physiotherapy improved walking distance and balance in chronic stroke survivors.
These gains persisted 12 weeks after the device was removed. The robotic device alone cannot be credited as the sole cause, as all participants also received standard care.
Key findings
01Participants using the home-based robotic device plus usual care showed significantly greater improvement in the Six Minute Walk Test compared to usual care alone at 10 weeks, and this improvement was maintained at 22 weeks.
02The intervention group demonstrated significant improvements in balance (Berg Balance Scale) and gait quality (Dynamic Gait Index) compared to controls, though the Berg Balance improvement did not reach the commonly accepted minimal clinically important difference.
03Accelerometry data showed the intervention group increased daily steps and time spent stepping while decreasing sedentary time, whereas the control group saw a decline in steps.
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
The sample size was small (34 participants) and recruited from a single private neuro-physiotherapy practice, meaning participants were likely highly motivated and able to afford care, which limits generalizability to the wider stroke population. The intervention group received both the robotic device and usual care physiotherapy. It is impossible to separate the specific contribution of the robot from the usual care, although the control group also received usual care. Some improvements, such as the 4.6-point change in the Berg Balance Scale, did not reach the minimal clinically important difference of 7 points, despite being statistically significant. The study did not analyze kinematic gait patterns, so the mechanism of improvement remains unclear. Attrition occurred, with two participants dropping out of the intervention group due to unrelated injury or assessment difficulties.
Declared interests
The study was funded by the University of Winchester. The robotic devices were provided free of charge by AlterG, who had no input or influence on the data analysis or manuscript preparation. One author has a relationship with the University of North Carolina but no stated conflict with AlterG.
The easy way to misread this
Do not assume the robotic device is the sole cause of improvement. All participants in the intervention group also received usual care physiotherapy, and the study design cannot isolate the robot's specific effect from the standard therapy they also received.