Exoskeleton-based training improves walking independence in incomplete spinal cord injury patients: results from a randomized controlled trial.

The study planned 24 participants in each group but analysed 21, so the results are underpowered and null findings may reflect too few participants. There was no 6-month follow-up, so durability of improvement is unknown. The trial was single centre and used only one device, so applicability to other centres is limited. Participants knew which treatment they received, so a placebo effect cannot be ruled out. The exoskeleton group appeared younger and had a shorter time since injury, although these demographic differences were not statistically significant. Exoskeleton guidance was fixed at 100% and was not adapted to each patient's walking capacity. The study did not measure balance, upper-limb movement or EMG, so the reason for the WISCI-II difference is unclear. Both groups continued usual medications and rehabilitation, and both received additional walking treatment, so the contribution of any single component cannot be separated.

No explicit conflicts-of-interest declaration is provided; the paper says recruitment stopped when the time limit set by financial sponsorship was reached.

Do not conclude that exoskeleton walking training is clearly superior for incomplete spinal cord injury. The main motor outcome did not favour the exoskeleton, and the only between-group improvement was on a walking independence scale in a small, unblinded trial.