Meta-analysis of the effects of lower extremity exoskeleton robot on the improvement of walking ability and curative effect in SCI patients
Background Spinal cord injury (SCI) leads to significant motor and sensory impairments, reducing independence and quality of life. Conventional rehabilitation often lacks the intensity and task specificity required for optimal gait recovery. Powered lower-limb exoskeletons have emerged as a promising adjunct to enhance functional outcomes through repetitive, task-oriented training. Objective This meta-analysis aimed to evaluate the effectiveness and safety of exoskeleton-assisted rehabilitation compared with conventional therapy in improving walking ability, motor function, and activities of daily living in individuals with SCI. Methods A systematic search of PubMed, Embase, Cochrane Library, Scopus, Web of Science, CNKI, Wanfang, and VIP databases was conducted for studies published between January 2016 and December 2024. Ten controlled trials involving 412 participants were included. Primary outcomes were Berg Balance Scale (BBS), 6-Minute Walk Distance (6MWD), Lower Extremity Motor Score (LEMS), Walking Index for Spinal Cord Injury II (WISCI-II) and Modified Barthel Index (MBI). Data were pooled using fixed- or random-effects models based on heterogeneity. Results Exoskeleton-assisted rehabilitation significantly improved balance (BBS: MD 4.84, 95% CI 4.19–5.50; p < 0.001), walking endurance (6MWD: MD 31.09 m, 95% CI 27.25–34.93; p < 0.001), LEMS (MD 10.00, 95% CI 8.31–11.69; p < 0.001), gait independence (WISCI-II: MD 3.25, 95% CI 2.65–3.85; p < 0.001), and activities of daily living (MBI: MD 3.44, 95% CI 1.23–5.65; p = 0.003). Improvements were also observed in the ASIA lower-limb motor score (MD 7.28, 95% CI 6.44–8.12; p < 0.001). Substantial heterogeneity was present in some outcomes. No serious adverse events related to exoskeleton use were reported across the included studies. Conclusion Exoskeleton-assisted rehabilitation is associated with statistically significant improvements in balance, walking performance, motor function, and functional independence in individuals with SCI compared with conventional therapy.