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References
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- Angela Vidal-Jordana
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[1]Wonsetler EC, Bowden MG. A systematic review of mechanisms of gait speed change post-stroke. Part 1: spatiotemporal parameters and asymmetry ratios. Topics in Stroke Rehabilitation. 2017; 24: 435–446. https://doi.org/10.1080/10749357.2017.1285746.
[2]Nagano H, Said CM, James L, Sparrow WA, Begg R. Biomechanical Correlates of Falls Risk in Gait Impaired Stroke Survivors. Frontiers in Physiology. 2022; 13: 833417. https://doi.org/10.3389/fphys.2022.833417.
[3]Alingh JF, Groen BE, Van Asseldonk EHF, Geurts ACH, Weerdesteyn V. Effectiveness of rehabilitation interventions to improve paretic propulsion in individuals with stroke - A systematic review. Clinical Biomechanics (Bristol, Avon). 2020; 71: 176–188. https://doi.org/10.1016/j.clinbiomech.2019.10.021.
[4]Li Y, Fan J, Yang J, He C, Li S. Effects of transcranial direct current stimulation on walking ability after stroke: A systematic review and meta-analysis. Restorative Neurology and Neuroscience. 2018; 36: 59–71. https://doi.org/10.3233/RNN-170770.
[5]Stinear CM, Lang CE, Zeiler S, Byblow WD. Advances and challenges in stroke rehabilitation. The Lancet. Neurology. 2020; 19: 348–360. https://doi.org/10.1016/S1474-4422(19)30415-6.
[6]Eng JJ, Pastva AM. Advances in Remote Monitoring for Stroke Recovery. Stroke. 2022; 53: 2658–2661. https://doi.org/10.1161/STROKEAHA.122.038885.
[7]Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, et al. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2016; 47: e98–e169. https://doi.org/10.1161/STR.0000000000000098.
[8]Pournajaf S, Calabrò RS, Naro A, Goffredo M, Aprile I, Tamburella F, et al. Robotic versus Conventional Overground Gait Training in Subacute Stroke Survivors: A Multicenter Controlled Clinical Trial. Journal of Clinical Medicine. 2023; 12: 439. https://doi.org/10.3390/jcm12020439.
[9]Koldaş Doğan Ş. Robot-assisted gait training in stroke. Turkish Journal of Physical Medicine and Rehabilitation. 2024; 70: 293–299. https://doi.org/10.5606/tftrd.2024.15681.
[10]Warutkar V, Dadgal R, Mangulkar UR. Use of Robotics in Gait Rehabilitation Following Stroke: A Review. Cureus. 2022; 14: e31075. https://doi.org/10.7759/cureus.31075.
[11]French B, Thomas LH, Coupe J, McMahon NE, Connell L, Harrison J, et al. Repetitive task training for improving functional ability after stroke. The Cochrane Database of Systematic Reviews. 2016; 11: CD006073. https://doi.org/10.1002/14651858.CD006073.pub3.
[12]Luo L, Meng H, Wang Z, Zhu S, Yuan S, Wang Y, et al. Effect of high-intensity exercise on cardiorespiratory fitness in stroke survivors: A systematic review and meta-analysis. Annals of Physical and Rehabilitation Medicine. 2020; 63: 59–68. https://doi.org/10.1016/j.rehab.2019.07.006.
[13]Bruni MF, Melegari C, De Cola MC, Bramanti A, Bramanti P, Calabrò RS. What does best evidence tell us about robotic gait rehabilitation in stroke patients: A systematic review and meta-analysis. Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia. 2018; 48: 11–17. https://doi.org/10.1016/j.jocn.2017.10.048.
[14]Postol N, Marquez J, Spartalis S, Bivard A, Spratt NJ. Do powered over-ground lower limb robotic exoskeletons affect outcomes in the rehabilitation of people with acquired brain injury? Disability and Rehabilitation. Assistive Technology. 2019; 14: 764–775. https://doi.org/10.1080/17483107.2018.1499137.
[15]Cho JE, Yoo JS, Kim KE, Cho ST, Jang WS, Cho KH, et al. Systematic Review of Appropriate Robotic Intervention for Gait Function in Subacute Stroke Patients. BioMed Research International. 2018; 2018: 4085298. https://doi.org/10.1155/2018/4085298.
[16]Tedla JS, Dixit S, Gular K, Abohashrh M. Robotic-Assisted Gait Training Effect on Function and Gait Speed in Subacute and Chronic Stroke Population: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. European Neurology. 2019; 81: 103–111. https://doi.org/10.1159/000500747.
[17]Higgins J. Cochrane handbook for systematic reviews of interventions, version 5.1.0. 2012. Available at: https://handbook-5-1.cochrane.org (Accessed: 20 February 2023)
[18]Sanabria AJ, Rigau D, Rotaeche R, Selva A, Marzo-Castillejo M, Alonso-Coello P. GRADE: Methodology for formulating and grading recommendations in clinical practice. Atencion Primaria. 2015; 47: 48–55. https://doi.org/10.1016/j.aprim.2013.12.013.
[19]Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ (Clinical Research Ed.). 2021; 372: n71. https://doi.org/10.1136/bmj.n71.
[20]Pieper D, Antoine SL, Mathes T, Neugebauer EAM, Eikermann M. Systematic review finds overlapping reviews were not mentioned in every other overview. Journal of Clinical Epidemiology. 2014; 67: 368–375. https://doi.org/10.1016/j.jclinepi.2013.11.007.
[21]Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ (Clinical Research Ed.). 2017; 358: j4008. https://doi.org/10.1136/bmj.j4008.
[22]Mc Master University. GRADEpro guideline development tool software Internet. Mc Master University; 2023. Available at: https://gradepro.org (Accessed: 11 July 2023).
[23]Zhang B, Wong KP, Kang R, Fu S, Qin J, Xiao Q. Efficacy of Robot-Assisted and Virtual Reality Interventions on Balance, Gait, and Daily Function in Patients With Stroke: A Systematic Review and Network Meta-analysis. Archives of Physical Medicine and Rehabilitation. 2023; 104: 1711–1719. https://doi.org/10.1016/j.apmr.2023.04.005.
[24]Taki S, Iwamoto Y, Imura T, Mitsutake T, Tanaka R. Effects of gait training with the Hybrid Assistive Limb on gait ability in stroke patients: A systematic review of randomized controlled trials. Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia. 2022; 101: 186–192. https://doi.org/10.1016/j.jocn.2022.04.001.
[25]Shakti D, Mathew L, Kumar N, Kataria C. Effectiveness of robo-assisted lower limb rehabilitation for spastic patients: A systematic review. Biosensors & Bioelectronics. 2018; 117: 403–415. https://doi.org/10.1016/j.bios.2018.06.027.
[26]Calafiore D, Negrini F, Tottoli N, Ferraro F, Ozyemisci-Taskiran O, de Sire A. Efficacy of robotic exoskeleton for gait rehabilitation in patients with subacute stroke: a systematic review. European Journal of Physical and Rehabilitation Medicine. 2022; 58: 1–8. https://doi.org/10.23736/S1973-9087.21.06846-5.
[27]Hsu TH, Tsai CL, Chi JY, Hsu CY, Lin YN. Effect of wearable exoskeleton on post-stroke gait: A systematic review and meta-analysis. Annals of Physical and Rehabilitation Medicine. 2023; 66: 101674. https://doi.org/10.1016/j.rehab.2022.101674.
[28]Nedergård H, Arumugam A, Sandlund M, Bråndal A, Häger CK. Effect of robotic-assisted gait training on objective biomechanical measures of gait in persons post-stroke: a systematic review and meta-analysis. Journal of Neuroengineering and Rehabilitation. 2021; 18: 64. https://doi.org/10.1186/s12984-021-00857-9.
[29]Rodríguez-Fernández A, Lobo-Prat J, Font-Llagunes JM. Systematic review on wearable lower-limb exoskeletons for gait training in neuromuscular impairments. Journal of Neuroengineering and Rehabilitation. 2021; 18: 22. https://doi.org/10.1186/s12984-021-00815-5.
[30]Hsu CY, Cheng YH, Lai CH, Lin YN. Clinical non-superiority of technology-assisted gait training with body weight support in patients with subacute stroke: A meta-analysis. Annals of Physical and Rehabilitation Medicine. 2020; 63: 535–542. https://doi.org/10.1016/j.rehab.2019.09.009.
[31]Schröder J, Truijen S, Van Criekinge T, Saeys W. Feasibility and effectiveness of repetitive gait training early after stroke: A systematic review and meta-analysis. Journal of Rehabilitation Medicine. 2019; 51: 78–88. https://doi.org/10.2340/16501977-2505.
[32]Moucheboeuf G, Griffier R, Gasq D, Glize B, Bouyer L, Dehail P, et al. Effects of robotic gait training after stroke: A meta-analysis. Annals of Physical and Rehabilitation Medicine. 2020; 63: 518–534. https://doi.org/10.1016/j.rehab.2020.02.008.
[33]Maranesi E, Riccardi GR, Di Donna V, Di Rosa M, Fabbietti P, Luzi R, et al. Effectiveness of Intervention Based on End-effector Gait Trainer in Older Patients With Stroke: A Systematic Review. Journal of the American Medical Directors Association. 2020; 21: 1036–1044. https://doi.org/10.1016/j.jamda.2019.10.010.
[34]Mehrholz J, Thomas S, Kugler J, Pohl M, Elsner B. Electromechanical-assisted training for walking after stroke. The Cochrane Database of Systematic Reviews. 2020; 10: CD006185. https://doi.org/10.1002/14651858.CD006185.pub5.
[35]Carpino G, Pezzola A, Urbano M, Guglielmelli E. Assessing Effectiveness and Costs in Robot-Mediated Lower Limbs Rehabilitation: A Meta-Analysis and State of the Art. Journal of Healthcare Engineering. 2018; 2018: 7492024. https://doi.org/10.1155/2018/7492024.
[36]Kim H, Park G, Shin JH, You JH. Neuroplastic effects of end-effector robotic gait training for hemiparetic stroke: a randomised controlled trial. Scientific Reports. 2020; 10: 12461. https://doi.org/10.1038/s41598-020-69367-3.
[37]Hesse S, Waldner A, Tomelleri C. Innovative gait robot for the repetitive practice of floor walking and stair climbing up and down in stroke patients. Journal of Neuroengineering and Rehabilitation. 2010; 7: 30. https://doi.org/10.1186/1743-0003-7-30.
[38]Tilson JK, Sullivan KJ, Cen SY, Rose DK, Koradia CH, Azen SP, et al. Meaningful gait speed improvement during the first 60 days poststroke: minimal clinically important difference. Physical Therapy. 2010; 90: 196–208. https://doi.org/10.2522/ptj.20090079.
[39]Perera S, Mody SH, Woodman RC, Studenski SA. Meaningful change and responsiveness in common physical performance measures in older adults. Journal of the American Geriatrics Society. 2006; 54: 743–749. https://doi.org/10.1111/j.1532-5415.2006.00701.x.
[40]Alghadir AH, Al-Eisa ES, Anwer S, Sarkar B. Reliability, validity, and responsiveness of three scales for measuring balance in patients with chronic stroke. BMC Neurology. 2018; 18: 141. https://doi.org/10.1186/s12883-018-1146-9.
[41]Flansbjer UB, Holmbäck AM, Downham D, Patten C, Lexell J. Reliability of gait performance tests in men and women with hemiparesis after stroke. Journal of Rehabilitation Medicine. 2005; 37: 75–82. https://doi.org/10.1080/16501970410017215.
[42]Fulk GD, He Y. Minimal Clinically Important Difference of the 6-Minute Walk Test in People With Stroke. Journal of Neurologic Physical Therapy: JNPT. 2018; 42: 235–240. https://doi.org/10.1097/NPT.0000000000000236.
[43]Xie L, Yoon BH, Park C, You JSH. Optimal Intervention Timing for Robotic-Assisted Gait Training in Hemiplegic Stroke. Brain Sciences. 2022; 12: 1058. https://doi.org/10.3390/brainsci12081058.
[44]Arboix A, Massons J, García-Eroles L, Targa C, Comes E, Parra O, et al. Nineteen-year trends in risk factors, clinical characteristics and prognosis in lacunar infarcts. Neuroepidemiology. 2010; 35: 231–236. https://doi.org/10.1159/000319460.
[45]Torres-Riera S, Arboix A, Parra O, García-Eroles L, Sánchez-López MJ. Predictive Clinical Factors of In-Hospital Mortality in Women Aged 85 Years or More with Acute Ischemic Stroke. Cerebrovascular Diseases (Basel, Switzerland). 2025; 54: 11–19. https://doi.org/10.1159/000536436.
[46]Pujadas Capmany R, Arboix A, Casañas-Muñoz R, Anguera-Ferrando N. Specific cardiac disorders in 402 consecutive patients with ischaemic cardioembolic stroke. International Journal of Cardiology. 2004; 95: 129–134. https://doi.org/10.1016/j.ijcard.2003.02.007.
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, Francisco Molina-Rueda 2, María Carratalá-Tejada 21 Escuela Internacional de Doctorado, Universidad Rey Juan Carlos. Rectorado – Delegación Madrid, 28008 Madrid, España
2 Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, 28922 Alcorcón, Madrid, España
Abstract
Gait training using robotic devices in stroke patients is a widely researched treatment modality. Therefore, there is a lot of heterogeneous information that needs to be synthesized, sorted, and classified. The aim of this work was to synthesize and analyze the scientific evidence on the application of robotic devices for gait training in people with stroke.
This overview of systematic reviews and meta-analysis was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Searches were performed in four electronic databases: PubMed, Scopus, Web of Science, and Cochrane Library Plus. Systematic reviews and meta-analyses that included randomized controlled trials (RCTs) that investigated the effects of robotic devices in combination or not with another physiotherapy treatment on gait recovery in stroke patients were included.
Thirteen studies with a total of 101 RCTs were included. Data regarding the participants, outcome measures, training protocols and main results were extracted. The A Messurement Tool to Assess Systematic Review (AMSTAR-2) scale and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of certainty of evidence were applied. Only one study had a high certainty of evidence; while four had a moderate certainty, six were classified as having a low certainty and two had a critically low quality.
Robotic gait training combined with physiotherapy improves walking speed after stroke, especially with end-effector devices. However, benefits do not reach clinically meaningful functional thresholds, and applicability is limited due to insufficient evidence, high costs, and limited accessibility.
CRD42021237915, https://www.crd.york.ac.uk/PROSPERO/view/CRD42021237915.
Keywords
- physical therapy modalities
- rehabilitation
- robotic devices
- stroke
- gait
References
- [1]
Wonsetler EC, Bowden MG. A systematic review of mechanisms of gait speed change post-stroke. Part 1: spatiotemporal parameters and asymmetry ratios. Topics in Stroke Rehabilitation. 2017; 24: 435–446. https://doi.org/10.1080/10749357.2017.1285746. - [2]
Nagano H, Said CM, James L, Sparrow WA, Begg R. Biomechanical Correlates of Falls Risk in Gait Impaired Stroke Survivors. Frontiers in Physiology. 2022; 13: 833417. https://doi.org/10.3389/fphys.2022.833417. - [3]
Alingh JF, Groen BE, Van Asseldonk EHF, Geurts ACH, Weerdesteyn V. Effectiveness of rehabilitation interventions to improve paretic propulsion in individuals with stroke - A systematic review. Clinical Biomechanics (Bristol, Avon). 2020; 71: 176–188. https://doi.org/10.1016/j.clinbiomech.2019.10.021. - [4]
Li Y, Fan J, Yang J, He C, Li S. Effects of transcranial direct current stimulation on walking ability after stroke: A systematic review and meta-analysis. Restorative Neurology and Neuroscience. 2018; 36: 59–71. https://doi.org/10.3233/RNN-170770. - [5]
Stinear CM, Lang CE, Zeiler S, Byblow WD. Advances and challenges in stroke rehabilitation. The Lancet. Neurology. 2020; 19: 348–360. https://doi.org/10.1016/S1474-4422(19)30415-6. - [6]
Eng JJ, Pastva AM. Advances in Remote Monitoring for Stroke Recovery. Stroke. 2022; 53: 2658–2661. https://doi.org/10.1161/STROKEAHA.122.038885. - [7]
Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, et al. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2016; 47: e98–e169. https://doi.org/10.1161/STR.0000000000000098. - [8]
Pournajaf S, Calabrò RS, Naro A, Goffredo M, Aprile I, Tamburella F, et al. Robotic versus Conventional Overground Gait Training in Subacute Stroke Survivors: A Multicenter Controlled Clinical Trial. Journal of Clinical Medicine. 2023; 12: 439. https://doi.org/10.3390/jcm12020439. - [9]
Koldaş Doğan Ş. Robot-assisted gait training in stroke. Turkish Journal of Physical Medicine and Rehabilitation. 2024; 70: 293–299. https://doi.org/10.5606/tftrd.2024.15681. - [10]
Warutkar V, Dadgal R, Mangulkar UR. Use of Robotics in Gait Rehabilitation Following Stroke: A Review. Cureus. 2022; 14: e31075. https://doi.org/10.7759/cureus.31075. - [11]
French B, Thomas LH, Coupe J, McMahon NE, Connell L, Harrison J, et al. Repetitive task training for improving functional ability after stroke. The Cochrane Database of Systematic Reviews. 2016; 11: CD006073. https://doi.org/10.1002/14651858.CD006073.pub3. - [12]
Luo L, Meng H, Wang Z, Zhu S, Yuan S, Wang Y, et al. Effect of high-intensity exercise on cardiorespiratory fitness in stroke survivors: A systematic review and meta-analysis. Annals of Physical and Rehabilitation Medicine. 2020; 63: 59–68. https://doi.org/10.1016/j.rehab.2019.07.006. - [13]
Bruni MF, Melegari C, De Cola MC, Bramanti A, Bramanti P, Calabrò RS. What does best evidence tell us about robotic gait rehabilitation in stroke patients: A systematic review and meta-analysis. Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia. 2018; 48: 11–17. https://doi.org/10.1016/j.jocn.2017.10.048. - [14]
Postol N, Marquez J, Spartalis S, Bivard A, Spratt NJ. Do powered over-ground lower limb robotic exoskeletons affect outcomes in the rehabilitation of people with acquired brain injury? Disability and Rehabilitation. Assistive Technology. 2019; 14: 764–775. https://doi.org/10.1080/17483107.2018.1499137. - [15]
Cho JE, Yoo JS, Kim KE, Cho ST, Jang WS, Cho KH, et al. Systematic Review of Appropriate Robotic Intervention for Gait Function in Subacute Stroke Patients. BioMed Research International. 2018; 2018: 4085298. https://doi.org/10.1155/2018/4085298. - [16]
Tedla JS, Dixit S, Gular K, Abohashrh M. Robotic-Assisted Gait Training Effect on Function and Gait Speed in Subacute and Chronic Stroke Population: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. European Neurology. 2019; 81: 103–111. https://doi.org/10.1159/000500747. - [17]
Higgins J. Cochrane handbook for systematic reviews of interventions, version 5.1.0. 2012. Available at: https://handbook-5-1.cochrane.org (Accessed: 20 February 2023) Cited within: 2Google Scholar - [18]
Sanabria AJ, Rigau D, Rotaeche R, Selva A, Marzo-Castillejo M, Alonso-Coello P. GRADE: Methodology for formulating and grading recommendations in clinical practice. Atencion Primaria. 2015; 47: 48–55. https://doi.org/10.1016/j.aprim.2013.12.013. - [19]
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ (Clinical Research Ed.). 2021; 372: n71. https://doi.org/10.1136/bmj.n71. - [20]
Pieper D, Antoine SL, Mathes T, Neugebauer EAM, Eikermann M. Systematic review finds overlapping reviews were not mentioned in every other overview. Journal of Clinical Epidemiology. 2014; 67: 368–375. https://doi.org/10.1016/j.jclinepi.2013.11.007. - [21]
Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ (Clinical Research Ed.). 2017; 358: j4008. https://doi.org/10.1136/bmj.j4008. - [22]
Mc Master University. GRADEpro guideline development tool software Internet. Mc Master University; 2023. Available at: https://gradepro.org (Accessed: 11 July 2023). Cited within: 1Google Scholar - [23]
Zhang B, Wong KP, Kang R, Fu S, Qin J, Xiao Q. Efficacy of Robot-Assisted and Virtual Reality Interventions on Balance, Gait, and Daily Function in Patients With Stroke: A Systematic Review and Network Meta-analysis. Archives of Physical Medicine and Rehabilitation. 2023; 104: 1711–1719. https://doi.org/10.1016/j.apmr.2023.04.005. - [24]
Taki S, Iwamoto Y, Imura T, Mitsutake T, Tanaka R. Effects of gait training with the Hybrid Assistive Limb on gait ability in stroke patients: A systematic review of randomized controlled trials. Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia. 2022; 101: 186–192. https://doi.org/10.1016/j.jocn.2022.04.001. - [25]
Shakti D, Mathew L, Kumar N, Kataria C. Effectiveness of robo-assisted lower limb rehabilitation for spastic patients: A systematic review. Biosensors & Bioelectronics. 2018; 117: 403–415. https://doi.org/10.1016/j.bios.2018.06.027. - [26]
Calafiore D, Negrini F, Tottoli N, Ferraro F, Ozyemisci-Taskiran O, de Sire A. Efficacy of robotic exoskeleton for gait rehabilitation in patients with subacute stroke: a systematic review. European Journal of Physical and Rehabilitation Medicine. 2022; 58: 1–8. https://doi.org/10.23736/S1973-9087.21.06846-5. - [27]
Hsu TH, Tsai CL, Chi JY, Hsu CY, Lin YN. Effect of wearable exoskeleton on post-stroke gait: A systematic review and meta-analysis. Annals of Physical and Rehabilitation Medicine. 2023; 66: 101674. https://doi.org/10.1016/j.rehab.2022.101674. - [28]
Nedergård H, Arumugam A, Sandlund M, Bråndal A, Häger CK. Effect of robotic-assisted gait training on objective biomechanical measures of gait in persons post-stroke: a systematic review and meta-analysis. Journal of Neuroengineering and Rehabilitation. 2021; 18: 64. https://doi.org/10.1186/s12984-021-00857-9. - [29]
Rodríguez-Fernández A, Lobo-Prat J, Font-Llagunes JM. Systematic review on wearable lower-limb exoskeletons for gait training in neuromuscular impairments. Journal of Neuroengineering and Rehabilitation. 2021; 18: 22. https://doi.org/10.1186/s12984-021-00815-5. - [30]
Hsu CY, Cheng YH, Lai CH, Lin YN. Clinical non-superiority of technology-assisted gait training with body weight support in patients with subacute stroke: A meta-analysis. Annals of Physical and Rehabilitation Medicine. 2020; 63: 535–542. https://doi.org/10.1016/j.rehab.2019.09.009. - [31]
Schröder J, Truijen S, Van Criekinge T, Saeys W. Feasibility and effectiveness of repetitive gait training early after stroke: A systematic review and meta-analysis. Journal of Rehabilitation Medicine. 2019; 51: 78–88. https://doi.org/10.2340/16501977-2505. - [32]
Moucheboeuf G, Griffier R, Gasq D, Glize B, Bouyer L, Dehail P, et al. Effects of robotic gait training after stroke: A meta-analysis. Annals of Physical and Rehabilitation Medicine. 2020; 63: 518–534. https://doi.org/10.1016/j.rehab.2020.02.008. - [33]
Maranesi E, Riccardi GR, Di Donna V, Di Rosa M, Fabbietti P, Luzi R, et al. Effectiveness of Intervention Based on End-effector Gait Trainer in Older Patients With Stroke: A Systematic Review. Journal of the American Medical Directors Association. 2020; 21: 1036–1044. https://doi.org/10.1016/j.jamda.2019.10.010. - [34]
Mehrholz J, Thomas S, Kugler J, Pohl M, Elsner B. Electromechanical-assisted training for walking after stroke. The Cochrane Database of Systematic Reviews. 2020; 10: CD006185. https://doi.org/10.1002/14651858.CD006185.pub5. - [35]
Carpino G, Pezzola A, Urbano M, Guglielmelli E. Assessing Effectiveness and Costs in Robot-Mediated Lower Limbs Rehabilitation: A Meta-Analysis and State of the Art. Journal of Healthcare Engineering. 2018; 2018: 7492024. https://doi.org/10.1155/2018/7492024. - [36]
Kim H, Park G, Shin JH, You JH. Neuroplastic effects of end-effector robotic gait training for hemiparetic stroke: a randomised controlled trial. Scientific Reports. 2020; 10: 12461. https://doi.org/10.1038/s41598-020-69367-3. - [37]
Hesse S, Waldner A, Tomelleri C. Innovative gait robot for the repetitive practice of floor walking and stair climbing up and down in stroke patients. Journal of Neuroengineering and Rehabilitation. 2010; 7: 30. https://doi.org/10.1186/1743-0003-7-30. - [38]
Tilson JK, Sullivan KJ, Cen SY, Rose DK, Koradia CH, Azen SP, et al. Meaningful gait speed improvement during the first 60 days poststroke: minimal clinically important difference. Physical Therapy. 2010; 90: 196–208. https://doi.org/10.2522/ptj.20090079. - [39]
Perera S, Mody SH, Woodman RC, Studenski SA. Meaningful change and responsiveness in common physical performance measures in older adults. Journal of the American Geriatrics Society. 2006; 54: 743–749. https://doi.org/10.1111/j.1532-5415.2006.00701.x. - [40]
Alghadir AH, Al-Eisa ES, Anwer S, Sarkar B. Reliability, validity, and responsiveness of three scales for measuring balance in patients with chronic stroke. BMC Neurology. 2018; 18: 141. https://doi.org/10.1186/s12883-018-1146-9. - [41]
Flansbjer UB, Holmbäck AM, Downham D, Patten C, Lexell J. Reliability of gait performance tests in men and women with hemiparesis after stroke. Journal of Rehabilitation Medicine. 2005; 37: 75–82. https://doi.org/10.1080/16501970410017215. - [42]
Fulk GD, He Y. Minimal Clinically Important Difference of the 6-Minute Walk Test in People With Stroke. Journal of Neurologic Physical Therapy: JNPT. 2018; 42: 235–240. https://doi.org/10.1097/NPT.0000000000000236. - [43]
Xie L, Yoon BH, Park C, You JSH. Optimal Intervention Timing for Robotic-Assisted Gait Training in Hemiplegic Stroke. Brain Sciences. 2022; 12: 1058. https://doi.org/10.3390/brainsci12081058. - [44]
Arboix A, Massons J, García-Eroles L, Targa C, Comes E, Parra O, et al. Nineteen-year trends in risk factors, clinical characteristics and prognosis in lacunar infarcts. Neuroepidemiology. 2010; 35: 231–236. https://doi.org/10.1159/000319460. - [45]
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