Efficacy of Robot-assisted Gait Training on Motor Dysfunction in Parkinson’s Disease: A GRADE Assessed Systematic Review and Meta-analysis
Anurag Jha1, Janu Chhetri2, Muhammad Moiz Javed3, Nirmal Paudel4, Munna William4, Adesh Kantha5, Inisha Sapkota2, Muhammad Nabeel Saddique1, Hamza Muhammad Jafar1
1King Edward Medical University, 2Fatima Jinnah Medical University, 3Geisinger Medical Center, 4Nishtar Medical University, 5Institute of Medicine
Objective:

Robot-assisted gait training (RAGT) is a promising technique aimed at improving motor function in PD. However, its effectiveness remains debated. This review aims to evaluate RAGT’s clinical effectiveness in PD.

Background:
Parkinson’s disease (PD) is one of the major neurodegenerative disorders leading to a variety of motor symptoms including tremor, rigidity, bradykinesia, postural instability and gait dysfunction, affecting people between 65 and 85 years of age. 
Design/Methods:

A comprehensive search was conducted across PubMed, Embase, Web of Science, and Cochrane Library up to May 2024. Pooled outcomes were presented as mean difference (MD) with 95% confidence intervals (CI) using the random-effects model. The I2 and X2 statistics were employed to evaluate interstudy heterogeneity. All the calculations were performed using RevMan 5.4 and R Studio (v4.3.3). 

Results:

A total of 21 RCTs involving 793 patients from 65 to 78 years of age; having Hoehn and Yahr score ranging between 1 and 4, were included in this review. Lokomat and Gait-Trainer GT1 were the main robotic devices used in the multi-session rehabilitation programs. RAGT significantly improved UPDRS-III (MD -3.34, 95% CI -5.02 to -1.66,  P<0.0001, I2=69%), 10-MWT  (MD 0.07, CI 0.03 to 0.11, P=0.001, I2=16% ), 6-MWT  (MD 18.10, CI 2.89 to 33.32, P=0.02, I2=90%), BBS (MD 2.95, CI = 1.75 to 4.14, P<0.00001, I2=63%), walking speed  (MD 3.20, CI 1.81 to 4.59, P<0.00001, I2=0%), stride length (MD 5.26, CI 3.29 to7.23, p<0.00001, I2=0%) and ABC (MD7.18, CI 4.45 to 9.91, P<0.00001, I2=11%). No significant differences for TUG (MD -0.58, CI -1.17 to 0.02, P=0.06, I2=7%), step length (MD 4.54, CI -1.08 to 10.17, P=0.11, I2=60%), and cadence (MD 4.00, CI -3.19 to 11.19; P=0.28, I2=70%) were observed.

Conclusions:

RAGT shows statistical efficacy, but lacks clinical efficacy. More high-quality studies are needed.

10.1212/WNL.0000000000216734
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