Hsu Ting-Hsuan, Tsai Chi-Lin, Chi Ju-Yang, Hsu Chih-Yang, Lin Yen-Nung
Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Australia.
Ann Phys Rehabil Med. 2023 Feb;66(1):101674. doi: 10.1016/j.rehab.2022.101674. Epub 2022 Nov 30.
Wearable exoskeletons are a recently developed technology.
The present systematic review aimed to investigate the effect of a wearable exoskeleton on post-stroke walking by considering its use in a gait training system and simply as an orthosis assisting walking.
We systematically searched for randomised and quasi-randomised controlled trials in PubMed, Scopus, CINAHL and Embase databases from their earliest publication record to July 2021. We chose reports of trials investigating the effects of exoskeleton-assisted training or the effects of wearing an exoskeleton to assist walking. A meta-analysis was conducted to explore the benefits of the wearable exoskeleton on mobility capacity, walking speed, motor function, balance, endurance and activities of daily living.
We included 13 studies (492 participants) comparing exoskeleton-assisted training with dose-matched conventional gait training. Studies addressing the effect of wearing a wearable exoskeleton were unavailable. As compared with conventional gait training at the end of the intervention, exoskeleton-assisted training was superior for walking speed (mean difference [MD] 0.13 m/s, 95% CI 0.05; 0.21) and balance (standardized MD [SMD] 0.3, 95% CI 0.07; 0.54). The subgroup with chronic stroke (i.e., > 6 months) presented the outcome favouring exoskeleton-assisted training regarding overall mobility capacity (SMD 0.37, 95% CI 0.04; 0.69). At the end of follow-up, exoskeleton-assisted training was superior to conventional gait training in overall mobility (SMD 0.45, 95% CI 0.07; 0.84) and endurance (MD 46.23 m, 95% CI 9.90; 82.56).
Exoskeleton-assisted training was superior to dose-matched conventional gait training in several gait-related outcomes at the end of the intervention and follow-up in this systematic review and meta-analysis, which may support the use of exoskeleton-assisted training in the rehabilitation setting. Whether wearing versus not wearing a wearable exoskeleton is beneficial during walking remains unknown.
可穿戴外骨骼是一项最近开发的技术。
本系统评价旨在通过考虑其在步态训练系统中的应用以及仅作为辅助行走的矫形器，研究可穿戴外骨骼对中风后行走的影响。
我们在PubMed、Scopus、CINAHL和Embase数据库中从最早的出版记录到2021年7月系统地检索随机和半随机对照试验。我们选择了研究外骨骼辅助训练效果或穿戴外骨骼辅助行走效果的试验报告。进行荟萃分析以探讨可穿戴外骨骼在移动能力、步行速度、运动功能、平衡、耐力和日常生活活动方面的益处。
我们纳入了13项研究（492名参与者），比较了外骨骼辅助训练与剂量匹配的传统步态训练。关于穿戴可穿戴外骨骼效果的研究未找到。与干预结束时的传统步态训练相比，外骨骼辅助训练在步行速度（平均差[MD]0.13 m/s，95%可信区间0.05；0.21）和平衡（标准化平均差[SMD]0.3，95%可信区间0.07；0.54）方面更优。慢性中风（即>6个月）亚组在总体移动能力方面呈现出支持外骨骼辅助训练的结果（SMD 0.37，95%可信区间0.04；0.69）。在随访结束时，外骨骼辅助训练在总体移动性（SMD 0.45，95%可信区间0.07；0.84）和耐力（MD 46.23 m，95%可信区间9.90；82.56）方面优于传统步态训练。
在本系统评价和荟萃分析中，在干预结束和随访时，外骨骼辅助训练在几个与步态相关的结果方面优于剂量匹配的传统步态训练，这可能支持在康复环境中使用外骨骼辅助训练。行走时穿戴与不穿戴可穿戴外骨骼是否有益仍不清楚。
