Effects of lower limb exoskeleton gait orthosis compared to mechanical gait orthosis on rehabilitation of patients with spinal cord injury: A systematic review and future perspectives

We aimed to systematically evaluate the walking efficiency of lower limb exoskeleton gait orthosis and mechanical gait orthosis in patients with spinal cord injury. Databases searched included: Web of Science, MEDLINE, Cochrane Library and Google Scholar. Articles published in English from 1970 to 2022 investigating the impact of lower limb exoskeleton gait orthosis versus mechanical gait orthosis on gait outcomes in patients with spinal cord injury were considered. Two researchers independently extracted data and filled out predesigned forms. Information including authors, year of study, methodological quality, participant characteristics, intervention and comparison details, outcomes and results. The primary outcomes were kinematic data; the secondary outcomes were clinical tests. Data synthesis using meta-analysis was not possible due to the diversity of study designs, methodologies, and outcome measures. A total of 11 trials and 14 types of orthotics were included. The information gathered generally supported the gait improving effects of lower limb exoskeleton gait orthosis and mechanical gait orthosis in both kinematic data and clinical tests among patients with spinal cord injury. This systematic review compared walking efficiency of patients with spinal cord injury wearing powered exoskeleton gait orthosis and non-powered mechanical gait orthosis. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions. Future research should focus on improving trial quality and comprehensive parametric analysis of subjects with different physical conditions.