The effectiveness of robotic-assisted gait training for paediatric gait disorders: systematic review.

Most included studies had a high risk of bias because they lacked randomisation, allocation concealment, blinding of participants or therapists, and adequate outcome reporting. The evidence base included only three randomised trials and many small uncontrolled studies, so natural development, selection or other therapy may explain positive results. Participants were mostly children with cerebral palsy at GMFCS levels I to IV, so results may not apply to children at GMFCS level V or to other gait disorders. Training schedules varied widely, and the review could not identify evidence-based intensity, duration or timing. Adverse events were monitored in only one study, so safety is not well established. No study reported cost or cost-benefit information. Only one small time-series study used a participation measure, so effects on daily-life participation are not established.

Do not read the many positive before-and-after reports as proof that robotic gait training works for every child with a gait disorder. The combined randomised evidence did not show a clear walking-speed advantage, and most studies had high risk of bias, small samples, and no control group.