Exoskeleton gait training to improve lower urinary tract function in people with motor-complete spinal cord injury: A randomized pilot trial.
Alison M M Williams, Emily Deegan, Matthias Walter and 2 others
PMID 34383958WHAT IT FOUND
Exoskeleton walking was feasible for people with complete spinal cord injury, with high adherence and one minor adverse event.
Urinary function changes were minor and variable, though incontinence improved in the Lokomat group. No clear benefit for bladder health was established.
Key findings
01Five participants completed all 36 training sessions, with only one mild adverse event recorded.
02Changes in urodynamic outcomes were minor and variable, falling largely within the range of normal variability.
03Urinary incontinence episodes improved for both participants in the Lokomat group, but neither Ekso participant had incontinence at baseline.
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 very small, with only five participants completing the study, which limits the ability to detect true changes in urinary function. Participants were not stratified by baseline urinary symptoms, leading to an imbalance where no Ekso participants had incontinence at the start, making comparisons with the Lokomat group ineffective. The study duration was longer than intended, taking up to 154 days instead of the planned 84 days, which may have influenced outcomes. Urodynamic measures have poor repeatability in people with spinal cord injury, and clinically significant change thresholds are not established.
Declared interests
The authors have no conflicts of interest to declare.
The easy way to misread this
Do not conclude that exoskeleton training improves bladder function or incontinence. The apparent improvement in the Lokomat group cannot be compared to the Ekso group because the Ekso participants had no incontinence at baseline, and overall urodynamic changes were within normal variability.