Exercise using a robotic knee orthosis in stroke patients with hemiplegia.
Shuhei Iida, Dai Kawakita, Takuya Fujita and 4 others
PMID 29200624WHAT IT FOUND
Walking speed, stride length, symmetry, and Berg balance scores improved after 10 days of robotic knee orthosis plus usual therapy in nine stroke patients.
Without a control group, natural recovery and extra exercise cannot be separated.
Key findings
01Gait speed was 13.8 ± 10.6 m/min before treatment, 22.7 ± 16.6 m/min after treatment, and 29.5 ± 22.8 m/min one month post treatment in a group receiving standard physical therapy plus robotic knee orthosis exercise.
02Berg Balance Scale score was 23.1 ± 9.6 before treatment, 33.8 ± 11.5 after treatment, and 39.5 ± 11.3 one month post treatment in a group receiving standard physical therapy plus robotic knee orthosis exercise.
03No significant changes were observed in affected-side step length or unaffected-side one-leg support percentage.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only nine patients were studied, and there was no control group, so the paper cannot show that the robotic knee orthosis caused the changes. The patients were 1 month and half to 3 months after stroke, a period when spontaneous recovery can be large, so some improvement may have happened anyway. The RKO-exercise was 20 minutes added to 60 minutes of standard physical therapy, so the extra exercise time may explain the changes. The paper lists multiple outcomes but does not name a primary outcome, so it is unclear which result was the main question. There was no comparison group, and the paper does not describe blinding of assessors or random allocation. The authors state that standard physical therapy might have produced similar improvements.
Declared interests
No funding or conflict-of-interest declaration is provided. The paper notes that therapists were trained by Alter-G trained physical therapists and the device is Alter-G.
The easy way to misread this
Do not read the improved walking and balance scores as evidence that the robotic knee orthosis works. The study had no control group, the patients were 1 month and half to 3 months after stroke when recovery can occur naturally, and they received 60 minutes of standard physical therapy plus 20 minutes of orthosis exercise.