Effectiveness of robot-assisted gait training on motor impairments in people with Parkinson’s disease: a systematic review and meta-analysis

Abstract

The aim of this systematic review and meta-analysis was to evaluate the effectiveness of robot-assisted gait training (RAGT) on motor impairments in people with Parkinson's disease (PD). A computer-based systematic literature search was performed in six databases according to PRISMA guidelines. Randomized controlled trials (RCTs) that assessed the effects of RAGT on motor impairments in people with PD were included. GRADE approach and PEDro scale were used to determine the studies' quality of evidence. Meta-analyses were performed by calculating the weighted mean difference (WMD) at 95% confidence interval. Seven RCTs (PEDro: 5-8) met the inclusion criteria for systematic review and meta-analyses. The meta-analysis showed significant improvement on Unified Parkinson Disease Rating Scale Part III after intervention [WMD=3.292; 95% confidence interval (CI)=1.378-5.207; P=0.000], and after 1-month follow-up (WMD=5.512; 95% CI=2.396-8.629; P=0.001). Stride length (WMD=9.283; 95% CI=7.153-11.414; P=0.00) and gait speed (WMD=0.166; 95% CI=-0.090 to 0.243; P=0.000) showed significant improvements after RAGT. Balance as measured by Berg Balance Scale was improved significantly after intervention (WMD=3.87; 95% CI=0.374-6.735; P=0.029) and at 1-month follow-up (WMD=3.87; 95% CI=1.324-6.413; P=0.002). The pooled analysis did not detect any significant changes regarding stride time, cadence and functional balance scales. GRADE level of evidence ranged between high and low. The RAGT showed better outcomes than conventional interventions on some motor aspects in PD. However, RAGT did not seem superior to control interventions. Further RCTs that examine the effect of RAGT on more specific outcomes and at different medication statuses are required.

Biofeedback Core Exercise Using Hybrid Assistive Limb for Physical Frailty Patients With or Without Parkinson's Disease

“…Cappecci et al reported that RAGT significantly improved endurance, gait capacity, motor symptoms, quality of life, and freezing gait (18). In addition, Alwardat et al's meta-analysis reported that RAGT showed better outcomes than conventional interventions in some motor aspects of PD (19). Robot-assisted rehabilitation enables standardized treatment regardless of the therapists' experience and repetitive exercise without patient's fatigue as shown in our results.…”

Rehabilitation of older people with Parkinson’s disease: an innovative protocol for RCT study to evaluate the potential of robotic-based technologies

“…In a recent systematic review and meta-analysis robotassisted gait training (RAGT) showed better outcomes than conventional interventions on some motor aspects in PD [23], and greater advantages than treadmill training for individuals with freezing of gait-related disability were observed in another study [24]. Upper limb motor performances in patients with PD were also improved after motor training aided by high technological devices [25].…”

Effectiveness of robot-assisted gait training on freezing of gait in people with Parkinson disease: evidence from a literature review

“…All studies reported that were no adverse events or side effects that occurred during and/or after the interventions. Numerous studies also emphasized improved motor impairments, gait and balance in participants when using RAGT (Alwardat et al, 2018b; Furnari et al, 2017; Picelli et al, 2012; Sale et al, 2012).…”

“…There is growing interest in using robot-assisted gait training (RAGT) as a new PT technology for meeting the therapeutic gaps associated with PD and FOG. In our recent systematic review and meta-analysis, RAGT showed better outcomes than conventional interventions on some motor aspects in PD (Alwardat et al, 2018b). In line with our results, previous studies in PD and other neurological disease such as stroke and spinal cord injury that used RAGT showed significant improvements in gait and balance, compared with conventional rehabilitation programs (Furnari et al, 2017; Picelli et al, 2012; Sale et al, 2012).…”

“…These approaches include transcranial direct current stimulation, auditory and visual cueing training and virtual reality training (Chang et al, 2017; Frazzitta et al, 2009; Killane et al, 2015). Many studies have shown the efficacy of PT interventions at improving specific impairments and functional limitations in PwPD (Alwardat et al, 2018b; Goodwin et al, 2008; Mehrholz et al, 2010). In particular, they have shown that PT interventions can reduce the incidence and duration of FOG episodes (Chang et al, 2017; Frazzitta et al, 2009; Killane et al, 2015; Pelosin et al, 2018).…”