Therapeutic Benefits of Robot-Assisted Gait Training in Individuals With Spinal Cord Injury: A Systematic Review and Meta-Analysis

BACKGROUND AND PURPOSE: To assess the efficacy of robot-assisted gait training (RAGT) in individuals with spinal cord injury, with a focus on motor function, quality of life (QoL), activities of daily living (ADL), cardiopulmonary function, psychological function, and bowel function. METHODS: Seven databases were searched from inception to March 26, 2025. The risk of bias and evidence certainty (The Grading of Recommendations Assessment, Development and Evaluation) were assessed. Effect sizes were reported as mean differences (MDs) or standardized mean differences (SMDs). Subgroup analyses were performed based on injury severity (The American Spinal Injury Association), exoskeleton type, intervention duration, and duration of injury (DOI). RESULTS: In total, 37 studies met eligibility criteria, with 30 included in the meta-analysis. The results demonstrated that RAGT significantly improved walking ability (SMD, 0.58; 95 % confidence interval [CI], 0.28-0.87; moderate certainty), muscle strength (MD, 1.81; 95% CI, 0.48-3.14; moderate certainty), QoL (SMD, 0.43; 95% CI, 0.02-0.85; low certainty), and ADL (SMD, 0.28; 95% CI, 0.11-0.45; moderate certainty) compared with control interventions. However, control interventions were superior in reducing muscle tone (MD, 0.23; 95% CI, 0.01-0.46; low certainty). No significant differences were observed in balance, psychological function, or cardiopulmonary function. Subgroup analysis revealed that both intervention duration and DOI moderated effects. DISCUSSION AND CONCLUSIONS: RAGT may effectively enhance walking ability, muscle strength, QoL, and ADL for spinal cord injury, while its benefits may be influenced by intervention duration and DOI. RAGT suggests potential superiority for muscle strength gains in protocols exceeding 8 weeks and balance recovery in subacute stages, whereas control interventions may be more effective for reducing muscle tone.