Systematic review on wearable lower-limb exoskeletons for gait training in neuromuscular impairments.
Antonio Rodríguez-Fernández, Joan Lobo-Prat, Josep M Font-Llagunes
PMID 33526065WHAT IT FOUND
Most evidence comes from small, short-term trials with few randomised comparisons.
Stroke studies show some gains over conventional therapy, but spinal cord injury research lacks randomised controls. Devices remain heavy, require staff supervision and walking aids, and have limited home-use data.
Key findings
01The field is dominated by observational and pilot studies, with only six randomised controlled trials among the 87 included papers.
02Randomised trials in stroke patients reported improvements in gait speed and independence compared to conventional therapy, whereas no randomised trials were found for spinal cord injury.
03Current devices are heavy and require supervision and walking aids, limiting independence and mobility during use.
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 review did not assess the quality or risk of bias of the included studies. The evidence base is small, with only six RCTs out of 87 studies. There are no randomised controlled trials for spinal cord injury, the most studied population. Safety data was reported in only 36 of the 87 studies, so adverse events may be underreported. Training protocols and outcome measures varied widely, making direct comparisons between devices and studies difficult.
Declared interests
The paper notes support from non-U.S. government sources. No commercial funding or author conflicts of interest related to the exoskeleton manufacturers are explicitly detailed in the provided text.
The easy way to misread this
Do not assume wearable exoskeletons are proven superior to conventional gait therapy. The majority of evidence comes from small, non-randomised studies, and the few randomised trials show mixed results, particularly for spinal cord injury where no RCTs exist.