What does evidence tell us about the use of gait robotic devices in patients with multiple sclerosis? A comprehensive systematic review on functional outcomes and clinical recommendations.
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Calabrò Rocco S, Cassio Anna, Mazzoli Davide, Andrenelli Elisa, Bizzarini Emiliana, Campanini Isabella, Carmignano Simona M, Cerulli Simona, Chisari Carmelo, Colombo Valentina, Dalise Stefania, Fundarò Cira, Gazzotti Valeria, Mazzoleni Daniele, Mazzucchelli Miryam, Melegari Corrado, Merlo Andrea, Stampacchia Giulia, Boldrini Paolo, Mazzoleni Stefano, Posteraro Federico, Benanti Paolo, Castelli Enrico, Draicchio Francesco, Falabella Vincenzo, Galeri Silvia, Gimigliano Francesca, Grigioni Mauro, Mazzon Stefano, Molteni Franco, Petrarca Maurizio, Picelli Alessandro, Senatore Michele, Turchetti Giuseppe, Morone Giovanni, Bonaiuti Donatella, Italian Consensus Conference on Robotics in Neurorehabilitation (CICERONE)
Аннотация
EVIDENCE ACQUISITION: We searched for and systematically reviewed evidence-based studies on gait robotic rehabilitation in MS, between January 1st, 2010 and December 31st, 2020, in the following databases: Cochrane Library, PEDro, PubMed and Google Scholar. The study quality was assessed by the 16-item assessment of multiple systematic reviews 2 (AMSTAR 2) and the 10-item PEDro scale for the other research studies.
EVIDENCE SYNTHESIS: After an accurate screening, only 17 papers were included in the review, and most of them (13 RCT) had a level II evidence. Most of the studies used the Lokomat as a grounded robotic device, two investigated the efficacy of end-effectors and two powered exoskeletons. Generally speaking, robotic treatment has beneficial effects on gait speed, endurance and balance with comparable outcomes to those of conventional treatments. However, in more severe patients (EDSS >6), robotics leads to better functional outcomes. Notably, after gait training with robotics (especially when coupled to virtual reality) MS patients also reach better non-motor outcomes, including spasticity, fatigue, pain, psychological well-being and quality of life. Unfortunately, no clinical indications emerge on the treatment protocols.
CONCLUSIONS: The present comprehensive systematic review highlights the potential beneficial role on functional outcomes of the lower limb robotic devices in people with MS. Future studies are warranted to evaluate the role of robotics not only for walking and balance outcomes, but also for other gait-training-related benefits, to identify appropriate outcome measures related to a specific subgroup of MS subjects' disease severity.