Robotic Rehabilitation for Gait Imbalance in Patients with Multiple Sclerosis (MS): a Systematic Review and Meta-Analysis.

Objective: To estimate the pooled effect of robotic rehabilitation on gait in subjects with multiple sclerosis (MS). We conducted a systematic search in PubMed, Scopus, EMBASE, IEEE and Web of Science databases on October 1 st 2022, without any time or language limitation. Also, we investigated the grey literature, including conference abstract and references of references, to identify potentially relevant articles. The primary outcomes were the six-minute walking test (6MWT) and Timed Up and Go (TUG). The risk of bias in the included studies was evaluated using the Cochrane's risk of bias tool for non-randomized studies (ROBINS-I) and the Cochrane risk-of-bias tool for randomized trials (RoB2). Meta-analyses were performed using a fixed-effects model as the heterogeneity between study results (I2) was less than 50%. The standardized mean difference (SMD) was calculated as the effect size for study outcomes. Our systematic search retrieved 6878 studies and, after deleting duplicate results, 5019 articles remained. Two researchers screened the titles and abstracts, with 4942 studies remaining for further screening. After full-text assessment, 12 studies were included for meta-analysis, most of which were conducted in the USA and Italy and were published between 2007 and 2022. The mean age of participants in the selected studies ranged between 46-55 years and the mean expanded disability status scale (EDSS) between 5 and 6.5. The SMD of 6MWT (AFTER-BEFORE) was 0.22 (95% CI -0.01-0.45) (I 2 =0%, P=0.90). The SMD of TUG (AFTER-BEFORE) was -0.29 (95% CI -0.56, -0.02) (I 2 =0%, P=0.70). This systematic review and meta-analysis concluded that robotic rehabilitation was effective for gait rehabilitation in patients with MS.