PTCase SeriesArchives of rehabilitation research and clinical translation2023

Robotic-Assisted Gait Training (RAGT) in Stroke Rehabilitation: A Pilot Study.

Mariana Vita Milazzotto Neves, Leonardo Furlan, Felipe Fregni and 2 others

PMID 36968170

WHAT IT FOUND

Stroke patients who received robotic gait training with an exoskeleton or end-effector plus conventional stroke rehabilitation had improved walking test scores, but the study was small, non-randomized, and cannot separate device effects from usual care.

Key findings

01After 36 sessions, G-EO patients showed statistically significant improvements on all functional tests used, while Lokomat patients showed significant improvements only on TUG, DGI, and BBS.

02The proportion of patients showing real improvements, defined as gains beyond random measurement error, was similar between the G-EO and Lokomat groups.

03All drop-outs were from the G-EO group, and 2 patients stopped because of knee pain.

STILL TO COME

How it was doneWhat they foundWhat it means for PTs

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What it does not show

The study analysed only 24 patients, and only 10 Lokomat and 9 G-EO patients completed, so small differences could be chance. Patients were not randomized; device choice depended mainly on scheduling availability, so groups may differ in ways not measured. Assessors knew which device each patient used, which can bias functional test results. The paper did not adjust for multiple comparisons, so some significant findings may be false positives. All drop-outs were from the G-EO group, and 2 patients stopped because of knee pain; excluding them may have made G-EO look better. Patients with FAC score below 2 were excluded, so results do not apply to the most severely impaired walkers. Most patients were in the chronic phase of stroke, so the study says little about early rehabilitation.

The easy way to misread this

Do not conclude that G-EO is better than Lokomat or that robot-assisted gait training caused the improvements. Patients also received conventional stroke rehabilitation, device assignment was not randomized, assessors were not blind, and multiple tests were not adjusted.

Read it on PubMed →