Yeh Shu-Wei, Lin Li-Fong, Tam Ka-Wai, Tsai Ching-Piao, Hong Chien-Hsiung, Kuan Yi-Chun
Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taoyuan City, Taiwan; School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Department of Physical Medicine and Rehabilitation, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan; Neuroscience Research Center, Taipei Medical University, Taiwan; Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taiwan.
Mult Scler Relat Disord. 2020 Mar 3;41:102034. doi: 10.1016/j.msard.2020.102034.
Multiple sclerosis is a progressive disease responsible for gait disabilities and cognitive impairment, which affect functional performance. Robot-assisted gait training is an emerging training method to facilitate body-weight-supported treadmill training in many neurologic diseases. Through this study, we aimed to determine the efficacy of robot-assisted gait training in patients with multiple sclerosis.
We performed a systematic review and meta-analysis of randomized controlled trials evaluating the effect of robot-assisted gait training for multiple sclerosis. We searched PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov registry for articles published before May 2019. The primary outcome was walking performance (gait parameters, balance, and ambulation capability). The secondary outcomes were changes in perceived fatigue, severity of spasticity, global mobility, physical and mental quality of life, severity of pain, activities of daily living, and treatment acceptance.
We identified 10 studies (9 different trials) that included patients with multiple sclerosis undergoing robot-assisted gait training or conventional walk training. The meta-analysis showed comparable effectiveness between robot-assisted gait training and conventional walking therapy in walking performance, quality of life, pain, or activities of daily living. The robot-assisted gait training was even statistically superior to conventional walking therapy in improving perceived fatigue (pooled SMD: 0.34, 95% CI: 0.02-0.67), spasticity (pooled SMD: 0.70, 95% CI: 0.08-1.33, I² = 53%), and global mobility (borderline) after the intervention.
Our results provide the most up-to-date evidence regarding the robot-assisted gait training on multiple sclerosis. In addition to the safety and good tolerance, its efficacy on multiple sclerosis is comparable to that of conventional walking training and is even superior in improving fatigue and spasticity.
多发性硬化症是一种进展性疾病，可导致步态障碍和认知功能损害，进而影响功能表现。机器人辅助步态训练是一种新兴的训练方法，可促进许多神经系统疾病患者在减重跑步机上的训练。通过本研究，我们旨在确定机器人辅助步态训练对多发性硬化症患者的疗效。
我们对评估机器人辅助步态训练对多发性硬化症疗效的随机对照试验进行了系统评价和荟萃分析。我们检索了PubMed、EMBASE、Cochrane图书馆和ClinicalTrials.gov注册库，以查找2019年5月之前发表的文章。主要结局指标为步行表现（步态参数、平衡能力和行走能力）。次要结局指标为疲劳感、痉挛严重程度、整体活动能力、身体和心理健康状况、疼痛严重程度、日常生活活动能力的变化以及治疗接受度。
我们纳入了10项研究（9项不同试验），这些研究的对象为接受机器人辅助步态训练或传统步行训练的多发性硬化症患者。荟萃分析显示，在步行表现、生活质量、疼痛或日常生活活动能力方面，机器人辅助步态训练与传统步行治疗的效果相当。在干预后，机器人辅助步态训练在改善疲劳感（合并标准化均数差：0.34，95%置信区间：0.02 - 0.67）、痉挛（合并标准化均数差：0.70，95%置信区间：0.08 - 1.33，I² = 53%）和整体活动能力（临界值）方面，在统计学上甚至优于传统步行治疗。
我们的研究结果提供了关于机器人辅助步态训练治疗多发性硬化症的最新证据。除了安全性和良好的耐受性外，其对多发性硬化症的疗效与传统步行训练相当，在改善疲劳和痉挛方面甚至更优。
