Effectiveness of overground robotic exoskeletons in early inpatient rehabilitation for incomplete spinal cord injury: a systematic review protocol

Background Spinal cord injury affects approximately 9 million people worldwide, with incomplete injuries representing the majority of cases and offering greater potential for functional recovery. Overground robotic exoskeletons have emerged as promising rehabilitation tools, yet evidence regarding their effectiveness specifically during early inpatient rehabilitation remains inadequately synthesised. Objectives To systematically evaluate the effectiveness of overground robotic exoskeletons compared to conventional rehabilitation for improving walking function in adults with incomplete spinal cord injury during early inpatient rehabilitation. Methods This protocol follows PRISMA-P guidelines. Searches will be conducted across MEDLINE, Embase, CINAHL, Cochrane Library, and PEDro from inception through December 2025. Randomised and non-randomised controlled trials will be included. Two reviewers will independently screen studies using Covidence, extract data, and assess risk of bias using RoB 2 and ROBINS-I tools. Meta-analysis will be conducted where appropriate. Discussion This protocol establishes a rigorous framework for synthesising evidence on early exoskeleton-assisted rehabilitation, addressing a critical gap in clinical practice guidelines for spinal cord injury rehabilitation.