Robotic exoskeleton-assisted walking performance in adults with motor-complete spinal cord injury: A systematic review and meta-analysis of single-arm studies

The objective was to evaluate mobility outcomes in individuals with exclusively motor-complete spinal cord injuries.

This systematic review included single-arm studies identified through searches in MEDLINE, Cochrane Library, and Embase databases, focusing on motor-complete spinal cord injuries and various types of exoskeletons. This review adopted a single-arm synthesis approach to provide descriptive estimates of performance during device-assisted walking, rather than comparative effectiveness. Performance parameters such as speed, time, distance, and the SCIM III (Spinal Cord Independence Measure) obtained during device use were evaluated. Studies with any follow-up duration were included, and a total of 10 studies met the eligibility criteria. The search covered studies published approximately between November 2012 and May 2024. Data were synthesized using a random-effects model to generate descriptive estimates.

In the analysis of data from 130 participants, performance-based outcomes during device-assisted ambulation were reported. The pooled mean distance in the 6-minute walk test (6MWT) was 74.41 meters (95% CI [42.57-106.25]; I² = 98%). The pooled mean time to complete the 10-meter walk test (10MWT) was 100.02 s (95% CI [27.11-172.94]; I² = 96%), with a corresponding pooled mean gait speed of 0.18 m/s (95% CI [0.11-0.26]; I² = 98%). The pooled mean SCIM III score obtained in the study context was 57.79 (95% CI [50.08-65.50]; I² = 86%).

This meta-analysis provides descriptive estimates of walking performance during robotic exoskeleton - assisted walking in adults with motor-complete spinal cord injuries. Given the single-arm design and high heterogeneity, results should be interpreted as descriptive estimates of device-assisted capacity rather than causal functional improvement. Controlled longitudinal studies are needed to assess clinical relevance beyond assisted use.