Effects of an exoskeleton robot on motor function in patients with spinal cord injuries: a systematic review and meta-analysis.

Abstract

<h4>Objective</h4>This meta-analysis aimed to evaluate the impact of exoskeleton robotic training on motor function in spinal cord injury (SCI) patients.<h4>Methods</h4>We systematically reviewed randomized and non-randomized controlled trials from five databases (PubMed, Embase, Cochrane Library, Scopus, Web of Science) up to September 2025.<h4>Results</h4>A total of 13 trials with 247 participants were included. Results showed that exoskeleton robotic training significantly improved several motor function measures: the 6-min walk test (6-MWT) (0.75 [95% CI = 0.42, 1.08]), 10-m walk test (0.91 [95% CI = 0.49, 1.33]), Walking Index for Spinal Cord Injury (WISCI-II) (0.76 [95% CI = 0.36, 1.15]), timed up and go (TUG) test (- 1.05 [95% CI =  - 1.50, - 0.60]), and lower extremity motor score (LEMS) (0.65 [95% CI = 0.40, 0.90]). Subgroup analysis indicated that improvements in walking speed were consistent regardless of injury duration (> 6 vs. < 6 months). In contrast, when stratified by cumulative training time, a non-linear dose-response relationship was observed, with the greatest improvement occurring at 1000-2000 min of training, while both lower and higher doses yielded attenuated effects. Although there was high heterogeneity in some measures (6-MWT, 10-MWT, WISCI-II, TUG), excluding individual studies did not significantly alter the findings, indicating stable results.<h4>Conclusion</h4>Exoskeleton robotics significantly improves motor function in SCI patients, with walking function benefiting both within and beyond 6 months after injury, although the effects of ultra-early (< 3 months) versus early (3-6 months) intervention remain unclear, with maximal improvements observed at medium intensity (cumulative training duration of 1000-2000 min).