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Background It was suggested that robot-assisted gait training (RAGT) should not be routinely provided to disabled patients in place of conventional over-ground walking training (CGT). There exist several randomised controlled trials reporting on RAGT for people with multiple sclerosis. However, the effectiveness of RAGT varies between studies with the effectiveness pointing in different directions. It might be possible that the effectiveness of RAGT and CGT depends on the disease related disabilities of the people included in the clinical studies. We aimed to systematically search RCTs and to perform a meta-regression to compare the effects of robot-assisted gait training in people with less and higher disease related disabilities. The Expanded Disability Status Scale (EDSS) scores were used to classify level of disability. Methods A systematic search was developed to search four electronic databases (MEDLINE, CENTRAL, EMBASE and CINAHL) for eligible articles. A random effects model was applied to meta-analyse the effects of the interventions. Meta-regression was performed with an uni-variable random effects model using baseline walking speed and EDSS to predict the between group effect. Results The search on databases resulted in 596 records and finally nine studies were included into the review. The pooled estimates of the effects for performance over short and long distance tests were small and non-significant: -0.08 SMD (95% CI: -0.51 to 0.35) and − 0.24 SMD (95% CI: -0.67 to 0.19). Neither baseline walking speed or disease related disability were related to the mean effect size. Discussion Future studies are needed to help clinicians to decide, which intervention should be allocated to the individual patient. Electronic supplementary material The online version of this article (10.1186/s12883-019-1321-7) contains supplementary material, which is available to authorized users.
Background It was suggested that robot-assisted gait training (RAGT) should not be routinely provided to disabled patients in place of conventional over-ground walking training (CGT). There exist several randomised controlled trials reporting on RAGT for people with multiple sclerosis. However, the effectiveness of RAGT varies between studies with the effectiveness pointing in different directions. It might be possible that the effectiveness of RAGT and CGT depends on the disease related disabilities of the people included in the clinical studies. We aimed to systematically search RCTs and to perform a meta-regression to compare the effects of robot-assisted gait training in people with less and higher disease related disabilities. The Expanded Disability Status Scale (EDSS) scores were used to classify level of disability. Methods A systematic search was developed to search four electronic databases (MEDLINE, CENTRAL, EMBASE and CINAHL) for eligible articles. A random effects model was applied to meta-analyse the effects of the interventions. Meta-regression was performed with an uni-variable random effects model using baseline walking speed and EDSS to predict the between group effect. Results The search on databases resulted in 596 records and finally nine studies were included into the review. The pooled estimates of the effects for performance over short and long distance tests were small and non-significant: -0.08 SMD (95% CI: -0.51 to 0.35) and − 0.24 SMD (95% CI: -0.67 to 0.19). Neither baseline walking speed or disease related disability were related to the mean effect size. Discussion Future studies are needed to help clinicians to decide, which intervention should be allocated to the individual patient. Electronic supplementary material The online version of this article (10.1186/s12883-019-1321-7) contains supplementary material, which is available to authorized users.
INTRODUCTION: There is growing evidence on the efficacy of gait robotic rehabilitation in patients with multiple sclerosis (MS), but most of the studies have focused on gait parameters. Moreover, clear indications on the clinical use of robotics still lack. as part of the cicEroNE italian consensus on robotic rehabilitation, the aim of this systematic review was to investigate the existing evidence concerning the role of lower limb robotic rehabilitation in improving functional recovery in patients with Ms. EVidENcE acQuisitioN: We searched for and systematically reviewed evidence-based studies on gait robotic rehabilitation in Ms, between January 1 st , 2010 and december 31 st , 2020, in the following databases: cochrane library, pEdro, pubMed and Google scholar. the study quality was assessed by the 16-item assessment of multiple systematic reviews 2 (aMstar 2) and the 10-item pEdro scale for the other research studies. EVidENcE syNthEsis: after an accurate screening, only 17 papers were included in the review, and most of them (13 rct) had a level ii evidence. Most of the studies used the Lokomat as a grounded robotic device, two investigated the efficacy of end-effectors and two powered exoskeletons. Generally speaking, robotic treatment has beneficial effects on gait speed, endurance and balance with comparable outcomes to those of conventional treatments. however, in more severe patients (Edss >6), robotics leads to better functional outcomes. Notably, after gait training with robotics (especially when coupled to virtual reality) Ms patients also reach better non-motor outcomes, including spasticity, fatigue, pain, psychological well-being and quality of life. unfortunately, no clinical indications emerge on the treatment protocols. CONCLUSIONS: The present comprehensive systematic review highlights the potential beneficial role on functional outcomes of the lower limb robotic devices in people with Ms. future studies are warranted to evaluate the role of robotics not only for walking and balance outcomes, but also for other gait-training-related benefits, to identify appropriate outcome measures related to a specific subgroup of MS subjects' disease severity.(Cite this article as: calabrò rs, cassio a, Mazzoli d, andrenelli E, bizzarini E, campanini i, et al.; italian consensus conference on robotics in Neurorehabilitation (cicEroNE). What does evidence tell us about the use of gait robotic devices in patients with multiple sclerosis? a comprehensive systematic review on functional outcomes and clinical recommendations.
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