Effectiveness of Robot-Assisted Gait Training in Stroke Rehabilitation: A Systematic Review and Meta-Analysis.

Abstract

<b>Background/Objectives:</b> Robotic-assisted gait training (RAGT) is a promising adjunct to conventional rehabilitation for stroke survivors. However, its additive benefit over standard therapy remains to be fully clarified. This systematic review and meta-analysis evaluated the effectiveness of combining RAGT with conventional rehabilitation in improving gait-related outcomes among individuals with stroke. <b>Methods:</b> We searched PubMed, Embase, CINAHL, and Cochrane CENTRAL through September 2024 for randomized controlled trials (RCTs) comparing combined RAGT and conventional rehabilitation versus conventional rehabilitation alone in adults post-stroke. Data were synthesized using a random-effects model, and subgroup analyses examined effects by intervention duration, stroke chronicity, and robotic system type. <b>Results:</b> Twenty-three RCTs (n = 907) were included. The combined intervention significantly improved gait function (SMD = 0.51, <i>p</i> = 0.001), gait speed (SMD = 0.47, <i>p</i> = 0.010), balance (MD = 4.58, <i>p</i> < 0.001), and ADL performance (SMD = 0.35, <i>p</i> = 0.001). Subgroup analyses revealed that end-effector robotic systems yielded superior outcomes compared to exoskeletons, particularly in subacute stroke patients. The most pronounced benefits were seen in gait velocity and dynamic balance, especially with ≤15 training sessions. <b>Conclusions:</b> Integrating RAGT with conventional rehabilitation enhances motor recovery and functional performance in stroke survivors. End-effector devices appear most effective in subacute phases, supporting individualized RAGT application based on patient and device characteristics.