Effects of Robot-Assisted Gait Training in Patients With Multiple Sclerosis

Abstract

Objective: This study aims to evaluate and compare the effects of conventional and robot-assisted gait training (RAGT) programs on fatigue, mood, and quality of life in patients with multiple sclerosis who have fatigue. Methods: In this single-blinded, randomized controlled study, 37 patients with multiple sclerosis were randomized into two groups: RAGT (n = 18) and conventional gait training (n = 19). The RAGT group had gait training with RoboGait, whereas the conventional gait training group received conventional physiotherapist-assisted gait training. Outcome measures were the Fatigue Severity Scale, Hospital Anxiety Depression Scale, Multiple Sclerosis Quality of Life-54, Extended Disability Status Scale, Functional Ambulation Category, Berg Balance Test, and 6-min walk test. Results: Baseline demographic, clinic, and functional data were similar. Both groups showed improvements in the Fatigue Severity Scale, Hospital Anxiety Depression Scale-Depression, Multiple Sclerosis Quality of Life, Berg Balance Test, and 6-min walk test scores after treatment. Only the RAGT group showed an improvement in Hospital Anxiety Depression Scale-Anxiety score. The RAGT group had better Fatigue Severity Scale, and Hospital Anxiety Depression Scale scores. Conclusion: In combination with the standard rehabilitation program, both RAGT and conventional gait training are effective for multiple sclerosis. However, RAGT has superior effects in terms of fatigue, depression, and anxiety. Therefore, it may be preferred in multiple sclerosis patients who exhibit prominent symptoms of fatigue, depression, or anxiety.

Effect of Robot-Assisted Gait Training on Multiple Sclerosis: A Systematic Review and Meta-analysis of Randomized Controlled Trials

“…41,54,55 Two studies used a wearable exoskeleton, 43,44 and the other 14 studies applied grounded exoskeletons. 41,42,45 -56 Regarding primary outcomes, 10 studies reported walking velocity as an outcome, 41,43,45,49,51 -53,55 -57 and 12 reported walking endurance. 41,42,44 -46,48,49,51 -53,55,56 Regarding secondary outcomes, 8 studies reported mobility, 43 -45,47,49,51 -53 8 reported balance, 41,42,45,47,49,52,53,57 8 reported fatigue, 42,43,45,48,49,52,54…”

“…41,42,44 -46,48,49,51 -53,55,56 Regarding secondary outcomes, 8 studies reported mobility, 43 -45,47,49,51 -53 8 reported balance, 41,42,45,47,49,52,53,57 8 reported fatigue, 42,43,45,48,49,52,54,57 7 reported QoL, 41,42,45,49,53,54,57 7 reported disease progression, 41,42,47,48,53 -55 3 reported pain, 48,52,54 4 reported activities of daily living, 41,47,48,53 and 2 reported spasticity. 41,52 The training duration was less than or equal to 4 weeks in 7 studies, 42,44,45,…”

“…Finally, 16 studies were included in our study. [41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] One study was not included in our quantitative analysis because it did not provide information on standard deviation and we could not contact the author with the e-mail address they provided. 54 Supplementary Figure 1 presents the flowchart of article selection.…”

“…All of the selected studies were RCTs. [41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] A total of 13 studies were parallel RCTs, [42][43][44][45][46][47][48][49][50][51][52][53]56 and 3 were crossover studies. 41,54,55 Two studies used a wearable exoskeleton, 43,44 and the other 14 studies applied grounded exoskeletons.…”

Relationship of Motor Impairment with Cognitive and Emotional Alterations in Patients with Multiple Sclerosis

“…Conversely, a correlation was found between state anxiety and walking resistance, and a trend in the correlation of this type of anxiety with balance. Relationships between emotional aspects and walking ability have already been evidenced by other authors [ 58 ], highlighting that, when applying a robot-assisted gait training therapy, better results are achieved in the Hospital Anxiety and Depression Scale (HADS) after also improving the same functional parameters of walking resistance and balance [ 59 ]. Therefore, greater walking ability and balance improve the emotional state of patients.…”