Overground robotic exoskeleton vs conventional therapy in inpatient stroke rehabilitation: results from a pragmatic, multicentre implementation programme.
Pui Kit Tam, Ning Tang, Nur Shafawati Binte Kamsani and 8 others
PMID 39762953WHAT IT FOUND
Overground robotic exoskeletons allowed stroke patients to walk significantly further during therapy than conventional physiotherapy.
However, functional gains were similar between groups overall. Only patients with moderate baseline impairment showed better motor function scores with the robot, though this finding requires cautious interpretation due to study limitations.
Key findings
01Patients using the exoskeleton walked significantly more distance during therapy sessions than the control group, particularly those with severe mobility limitations.
02Overall functional outcomes (walking ability, balance, daily mobility) improved in both groups, with no significant difference between the exoskeleton and conventional therapy.
03A subgroup of patients with moderate baseline impairment (FAC 1) showed significantly better improvement in motor function scores with the exoskeleton compared to controls.
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
Participants chose their treatment group, leading to selection bias; the exoskeleton group was more impaired at baseline. Therapists assessing outcomes were not blinded to the treatment received, which could bias functional scores. The dose of training was low (average 455 steps per session), which is less than what is typically used in trials showing robotic benefits. The significant finding for the moderate impairment subgroup was based on a small number of participants and may not be reliable. Missing data was common for most outcomes due to administrative reasons, though sensitivity analysis suggested this did not alter the main conclusions.
Declared interests
The IMOVE programme was funded by the Temasek Foundation Cares, Trailblazer Foundation, and Community Silver Trust in Singapore. The authors declared no other conflicts of interest.
The easy way to misread this
Do not conclude that robotic exoskeletons are superior to conventional therapy for all stroke patients. The study was not randomised, and the only significant functional benefit (for the moderate impairment subgroup) was small and potentially due to chance. The main proven benefit is increased walking distance during therapy, not necessarily better long-term recovery.