Gait training with a wearable powered robot during stroke rehabilitation: a randomized parallel-group trial.
Daichi Miyagawa, Akira Matsushima, Yoichi Maruyama and 4 others
PMID 37118743WHAT IT FOUND
A wearable robot did not improve walking speed or distance more than standard therapist-assisted gait training in stroke patients.
Both groups improved similarly, so the robot offers no clear advantage over conventional care for these primary outcomes.
Key findings
01Improvement in 10-meter walking time was 20.6% in the robot group and 13.9% in the conventional group, but the difference was not statistically significant.
02Improvement in 6-minute walking distance was 16.8% in the robot group and 19.4% in the conventional group, with no significant difference between them.
03Secondary gait parameters (stride duration and cadence) improved significantly more in the robot group than the conventional group, though this did not translate to a significant difference in the primary speed outcome.
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 (35 analysed), which may have reduced the power to detect small but clinically relevant differences. Participants had relatively mild hemiparesis at baseline (average gait speed 0.90 m/s), raising the possibility of a ceiling effect that limits the potential for improvement. The robot's assistance parameters were not fully individualized (synchronization gain was fixed), which may have prevented optimization of the therapy for each patient. The study duration was short (15 days), so long-term effects are unknown.
Declared interests
The study was funded by the Japan Agency for Medical Research and Development. The authors did not report commercial conflicts of interest with the device manufacturer.
The easy way to misread this
Do not assume the robot is ineffective because the primary outcomes were null. The secondary analysis showed significant improvements in stride duration and cadence for the robot group, and gait speed improvement was very close to statistical significance. The null primary result may be due to the small sample size and the high baseline function of participants (ceiling effect), rather than a lack of biological effect.