Effects of Exoskeleton Robots on Balance and Lower Limb Function of Patients with Stroke： A Meta-Analysis

ObjectiveTo evaluate the effects of exoskeleton robot training on balance and lower limb function of patients with stroke by meta-analysis.MethodsData were searched and retrieved from the database of China National Knowledge Infrastructure (CNKI), Wanfang Data, Chinese Science and Technology Periodical Database (VIP), PubMed, Cochrane Library, EMbase, and Web of Science. The randomized controlled trials (RCTs) of exoskeleton robots training on balance and lower limb function of patients with stroke were included, and the retrieval time was from the database inception to June 2024. The primary outcome indicators included Berg Balance Scale (BBS) score and Fugl-Meyer Assessment of Lower Extremity (FMA-LE) score. Data extraction and literature quality assessment were independently conducted by two researchers, and the meta-analysis was performed using Stata 16.0 software. Continuous variables were expressed by weighted mean difference (WMD) with 95% confidence interval (CI). The heterogeneity was determined according to the <italic>I </italic>² value. If <italic>I </italic>²≤50% and <italic>P</italic>≥0.1, indicating low or no heterogeneity among the studies, a fixed-effect model would be used; if <italic>P</italic>&lt;0.1, <italic>I </italic>²&gt; 50%, indicating high heterogeneity, a random effect model would be used.ResultsA total of 9 RCTs were included, involving 467 patients. The meta-analysis results showed that, compared with the control group, BBS score in the experimental group after treatment was significantly higher [<italic>WMD</italic>=2.24, 95% <italic>CI </italic>(0.57, 3.91), <italic>Z</italic>=2.63, <italic>P</italic>=0.009] and FMA-LE score was significantly higher [<italic>WMD</italic>=2.30, 95% <italic>CI</italic>=(1.39, 3.21), <italic>Z</italic>=4.97, <italic>P</italic>&lt;0.001]. Subgroup meta-analysis of BBS scores showed that, when gait training lasted ≤30 minutes, BBS score in the experimental group after treatment was significantly higher than the control group [<italic>WMD</italic>=2.49, 95% <italic>CI </italic>(0.76, 4.23), <italic>Z</italic>=2.82, <italic>P</italic>=0.005]; when gait training duration was&gt;30 minutes, there was no statistically significant difference in BBS scores between two groups [<italic>WMD</italic>=-1.04, 95% <italic>CI</italic>=(-7.23, 5.15), <italic>Z</italic>=-0.33, <italic>P</italic>=0.743]; when the intervention period was ≤4 weeks, BBS score in the experimental group after treatment was significantly higher than the control group [<italic>WMD</italic>=1.86, 95% <italic>CI</italic>=(0.10, 3.62), <italic>Z</italic>=2.07, <italic>P</italic>=0.038]; when the intervention period was &gt;4 weeks, BBS score in the experimental group after treatment was significantly higher than the control group [<italic>WMD</italic>=5.57, 95% <italic>CI</italic>=(0.31,10.82), <italic>Z</italic>=2.08, <italic>P</italic>=0.038]. Subgroup analysis of FMA-LE scores showed that, when gait training duration was≤30 minutes, FMA-LE score in the experimental group after treatment was significantly higher than the control group [<italic>WMD</italic>=2.29, 95% <italic>CI</italic>=(1.35,2.23), <italic>Z</italic>=4.78, <italic>P</italic>&lt;0.001]; when gait training duration was &gt;30 minutes, there was no statistically significant difference in FMA-LE scores between the two groups [<italic>WMD</italic>=2.45, 95% <italic>CI</italic>=(-1.04, 5.94), <italic>Z</italic>=1.38, <italic>P</italic>=0.169]; when the intervention period was ≤4 weeks, FMA-LE score in the experimental group after treatment was significantly higher than the control group [<italic>WMD</italic>=1.96, 95% <italic>CI</italic>=(0.71, 3.22), <italic>Z</italic>=2.43, <italic>P</italic>=0.002]; when the intervention period was &gt;4 weeks, FMA-LE score in the experimental group after treatment was significantly higher than the control group [<italic>WMD</italic>=2.66, 95% <italic>CI</italic>=(1.35, 3.97), <italic>Z</italic>=2.77, <italic>P</italic>&lt;0.001].ConclusionExoskeleton robot training can effectively improve balance and lower limb motor function of patients with stroke, and the improvement effect of short-term exoskeleton robot training is more obvious.