Robot-assisted training for post-stroke lower-limb dysfunction: an umbrella review

This study aimed to reappraise published systematic reviews and meta-analyses on robot-assisted training for lower-limb motor dysfunction after stroke and evaluate their methodological quality, reporting completeness, and certainty of evidence.

Seven databases were searched, including CNKI, Wanfang, VIP, PubMed, Cochrane Library, Embase, and Web of Science, from inception to January 15, 2026. Eligible studies were systematic reviews or meta-analyses that were based on randomized controlled trials. Two reviewers independently performed study selection, data extraction, and quality appraisal. The methodological quality of the included reviews was assessed using A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2, and the reporting of this umbrella review followed the Preferred Reporting Items for Overviews of Reviews (PRIOR) guideline. The reporting completeness of the included systematic reviews and meta-analyses was evaluated using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 checklist. The certainty of evidence was graded using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

Nineteen reviews were included, comprising eight Chinese and 11 English publications. Primary-study overlap across reviews was moderate (CCA = 7.44%). According to AMSTAR 2, three reviews were rated as high quality, six as moderate quality, six as low quality, and four as critically low quality. PRISMA completeness scores ranged from 14.5 to 23.5 out of a maximum possible score of 27. Among the 70 extracted outcomes, none was rated as high-certainty evidence, 20 were of moderate certainty, 32 were of low certainty, and 18 were of very low certainty. Overall, robot-assisted training showed potential benefits for balance and lower-extremity motor function, whereas evidence for walking-related outcomes remained less consistent.

Evidence was most consistent for balance and lower-extremity motor impairment, whereas findings for walking independence, endurance, functional mobility, and gait speed were less consistent and generally supported by low-to-moderate certainty evidence. More rigorously designed primary trials and better-conducted systematic reviews are needed.

The review protocol was registered under Prospero, https://www.crd.york.ac.uk/PROSPERO/home (Registration No: CRD420261419692).