2024, Vol. 28 ›› Issue (2): 321-328

Efficacy of rehabilitation exoskeleton robots on post-stroke lower limb motor dysfunction: a Meta-analysis

Chang Wanpeng1, Zhang Zhongwen2, Yang Yulin1, Zi Yang3, Yang Mengqi1, Du Bingyu1, Wang Nan1, Yu Shaohong3, 4   

Abstract: OBJECTIVE: To systematically evaluate the efficacy of rehabilitation exoskeleton robots on the lower limb motor function of stroke patients using Meta-analysis and to compare the efficacy of different lower limb exoskeleton robots, so as to provide a theoretical basis for the scientific selection of suitable exoskeleton robots for patients with post-stroke lower limb motor dysfunction.
METHODS: Computer searches of the Cochrane Library, PubMed, Web of Science, Embase, CNKI, VIP, and WanFang Data were conducted to collect randomized controlled clinical studies on exploring lower extremity rehabilitation exoskeleton robots to improve lower limb motor function in stroke patients published from database inception to November 2022. Two researchers conducted the literature search and screening. The quality of the included literature was evaluated using the Cochrane 5.1.0 risk of bias assessment tool and the Jadad scale. Meta-analysis was performed using RevMan 5.4 and Stata 17.0 software.
RESULTS: (1) Finally 22 publications were included, involving 865 patients (n=436 in the test group and n=429 in the control group), and the Jadad score showed that all the included articles were   of high quality. (2) Meta-analysis results showed that the exoskeleton robot significantly improved the Fugl-Meyer Assessment of Lower Extremity score (mean difference [MD]=2.63, 95% confidence interval [CI]: 1.87-3.38, P < 0.05), Berg Balance Scale score (MD=3.62, 95% CI: 1.21-6.03, P < 0.05), Timed Up and Go score (MD=-2.77, 95% CI: -4.48 to -1.05, P < 0.05) and step frequency score (MD=3.15, 95% CI: 1.57-4.72, P < 0.05) in stroke patients compared with the control group. However, there was no significant improvement in the Functional Ambulation Category Scale score (MD=0.30, 95% CI: -0.01 to 0.61, P > 0.05) and 6-minute walk test score (MD=3.77, 95% CI: -6.60 to 14.14, P > 0.05). (3) Network Meta-analysis results showed that   compared with the conventional rehabilitation therapy, both the level-walking exoskeleton (MD=10.23, 95% CI: 3.81-27.49, P < 0.05) and the body-weight support exoskeleton (MD=33.66, 95% CI: 11.49-98.54, P < 0.05) improved the Fugl-Meyer Assessment of Lower Extremity score. Compared with the conventional rehabilitation therapy, body-weight support exoskeleton significantly improved the Berg Balance Scale scores (MD=79.86, 95% CI: 2.34-2 725.99, P < 0.05). In terms of Fugl-Meyer Assessment of Lower Extremity and Berg Balance Scale scores, the ranking results were body-weight support exoskeleton > level-walking exoskeleton > conventional rehabilitation therapy. Compared with the conventional rehabilitation therapy, level-walking exoskeleton significantly improved the Functional Ambulation Category Scale score (MD=1.38, 95% CI: 1.00-1.90, P < 0.05) and body-weight support exoskeleton significantly improved the Timed Up and Go score (MD=0.07, 95% CI: 0.01-0.51, P < 0.05). In terms of Functional Ambulation Category Scale and Timed Up and Go scores, the ranking results were level-walking exoskeleton > body-weight support exoskeleton > conventional rehabilitation therapy.
CONCLUSION: Rehabilitation exoskeleton robots can improve balance, walking and activities of daily living in stroke patients, with body-weight support exoskeleton being more effective in improving lower limb motor function and balance and level walking exoskeleton being more effective in improving functional walking and transfer.

Key words: stroke, strokes, lower extremity motor function, gait, walking, balance, rehabilitation robot, exoskeleton, systematic review, network meta-analysis