Powered knee-assisting exoskeletons for gait rehabilitation: a systematic review and meta-analysis on clinical outcomes

BACKGROUND: This systematic review and meta-analysis aim to evaluate the clinical outcomes of powered knee-assisting exoskeletons (PKAEs) in individuals with gait disorders. The primary goal is to compare functional outcomes and spatiotemporal gait parameters between PKAEs and conventional physiotherapy (CPT). METHODS: A comprehensive literature search was conducted in PubMed®, Embase®, Scopus®, and Web of Science™ for articles published up to October 2024. Controlled clinical trials involving PKAE-based rehabilitation in patients with gait disorders were included. Data extraction and bias assessment were independently performed by two reviewers using established tools (RoB-I and ROBINS-I). Effect sizes were calculated using random-effects models. RESULTS: Fifteen studies (9 randomized and 6 non-randomized clinical trials) met the inclusion criteria. Pooled analyses showed significant improvements in gait speed for PKAEs compared to CPT at post-treatment (SMD = 0.40; 95% CI 0.01-0.79), but no significant differences were found in other outcomes, including the 6-min walk test, 10-m walk test, cadence, timed up and go, timed stair test, and functional independence measure, between the PKAE and CPT groups. Other outcomes, such as balance, gait symmetry, and metabolic efficiency, were explored qualitatively due to the insufficient number of studies for meta-analysis. CONCLUSION: PKAEs demonstrated superior results in gait speed but showed comparable findings to CPT in other outcomes, suggesting their potential in gait rehabilitation. However, further research is required to assess their long-term clinical value and to identify the specific patient populations that would benefit most from their use. STUDY REGISTRATION: Registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the code CRD42024626418.