Overground robotic exoskeleton vs conventional therapy in inpatient stroke rehabilitation: results from a pragmatic, multicentre implementation programme
Abstract Background Despite the reported efficacy of overground robotic exoskeleton (ORE) for rehabilitation of mobility post-stroke, its effectiveness in real-world practice is still debated. We analysed prospectively collected data from Improving Mobility Via Exoskeleton (IMOVE), a multicentre cli...
Saved in:
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-01-01
|
| Series: | Journal of NeuroEngineering and Rehabilitation |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12984-024-01536-1 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1841544931242409984 |
|---|---|
| author | Pui Kit Tam Ning Tang Nur Shafawati Binte Kamsani Thian Yong Yap Ita Coffey-Aladdin Shi Min Goh Jean Pei Pei Tan Yook Cing Lui Rui Ling Lee Ramaswamy Suresh Effie Chew |
| author_facet | Pui Kit Tam Ning Tang Nur Shafawati Binte Kamsani Thian Yong Yap Ita Coffey-Aladdin Shi Min Goh Jean Pei Pei Tan Yook Cing Lui Rui Ling Lee Ramaswamy Suresh Effie Chew |
| author_sort | Pui Kit Tam |
| collection | DOAJ |
| description | Abstract Background Despite the reported efficacy of overground robotic exoskeleton (ORE) for rehabilitation of mobility post-stroke, its effectiveness in real-world practice is still debated. We analysed prospectively collected data from Improving Mobility Via Exoskeleton (IMOVE), a multicentre clinical implementation programme of ORE enrolling participants with various neurological conditions and were given options to choose between 12 sessions of ORE or conventional therapy (control). Methods This is analysis of participants under IMOVE who fulfilled the following criteria (i) primary diagnosis was stroke (ischemic, hemorrhagic; first or recurrent), (ii) onset of stroke was within 9 months and (iii) the intervention was during inpatient stay. They should also fulfill the general IMOVE inclusion and exclusion criteria which were resembling general clinical and manufacturing criteria of ORE. Outcome measures included Functional Ambulatory Category (FAC), Rivermead Mobility Index (RMI), Functional Independence Measure (FIM) and Clinical Outcome Variable Scale (COVS), measured immediately before and after the 12 sessions of therapy, and mean distance walked per session. Results Of 149 participants (105 OREs and 44 controls), both groups improved significantly in motor outcomes with no significant between-group differences. Participants with baseline FAC 1 had significantly greater improvement in motor sub-score of FIM (FIM-motor) compared to controls (mean difference 8.4, 95% CI 0.65–16.07, ηp 2 = 0.136, p = 0.034). The mean distance walked per session for ORE group was almost three times that of control for those with baseline FAC 0 (121.5 [SD 31.1]m vs 35.0 [SD 41.0]m, 95% CI 62.2–110.9, d = 2.54 p < 0.001) and FAC 1 (145.8 [SD 31.6]m vs 52.2 [SD 42.5]m, 95% CI 61.8–125.2, d = 2.71, p < 0.001). The difference was not observed for FAC 2 to 3 (162.9 [SD 29.2]m vs 134.2 [SD 87.5]m, 95% CI −22.2 to 79.7, d = 0.41, p = 0.252). Conclusion In a pragmatic setting, use of ORE for gait training enabled patients with lower ambulatory capacity to walk longer distances during therapy sessions. Patients who required continuous assistance during ambulation (FAC 1) had significantly better gains in FIM-motor compared to conventional therapy, suggesting possible benefit of ORE for this group. Trial Registration The trial was registered with clinicaltrials.gov (NCT05659121) on April 14, 2022. |
| format | Article |
| id | doaj-art-94e7c690a4804189a75fd9c6f7a553e0 |
| institution | Kabale University |
| issn | 1743-0003 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of NeuroEngineering and Rehabilitation |
| spelling | doaj-art-94e7c690a4804189a75fd9c6f7a553e02025-01-12T12:10:40ZengBMCJournal of NeuroEngineering and Rehabilitation1743-00032025-01-012211910.1186/s12984-024-01536-1Overground robotic exoskeleton vs conventional therapy in inpatient stroke rehabilitation: results from a pragmatic, multicentre implementation programmePui Kit Tam0Ning Tang1Nur Shafawati Binte Kamsani2Thian Yong Yap3Ita Coffey-Aladdin4Shi Min Goh5Jean Pei Pei Tan6Yook Cing Lui7Rui Ling Lee8Ramaswamy Suresh9Effie Chew10Division of Rehabilitation Medicine, Department of Medicine, National University HospitalDivision of Rehabilitation Medicine, Department of Medicine, National University HospitalDepartment of Rehabilitation, Alexandra Hospital, National University Health SystemRehabilitation Department, St Luke’s HospitalJurong Community HospitalStroke Support StationDepartment of Allied Health, NTUC Health Co-operative LtdSt Luke’s ElderCare LtdRehabilitation Department, St Luke’s HospitalDepartment of Rehabilitation, Alexandra Hospital, National University Health SystemDivision of Rehabilitation Medicine, Department of Medicine, National University HospitalAbstract Background Despite the reported efficacy of overground robotic exoskeleton (ORE) for rehabilitation of mobility post-stroke, its effectiveness in real-world practice is still debated. We analysed prospectively collected data from Improving Mobility Via Exoskeleton (IMOVE), a multicentre clinical implementation programme of ORE enrolling participants with various neurological conditions and were given options to choose between 12 sessions of ORE or conventional therapy (control). Methods This is analysis of participants under IMOVE who fulfilled the following criteria (i) primary diagnosis was stroke (ischemic, hemorrhagic; first or recurrent), (ii) onset of stroke was within 9 months and (iii) the intervention was during inpatient stay. They should also fulfill the general IMOVE inclusion and exclusion criteria which were resembling general clinical and manufacturing criteria of ORE. Outcome measures included Functional Ambulatory Category (FAC), Rivermead Mobility Index (RMI), Functional Independence Measure (FIM) and Clinical Outcome Variable Scale (COVS), measured immediately before and after the 12 sessions of therapy, and mean distance walked per session. Results Of 149 participants (105 OREs and 44 controls), both groups improved significantly in motor outcomes with no significant between-group differences. Participants with baseline FAC 1 had significantly greater improvement in motor sub-score of FIM (FIM-motor) compared to controls (mean difference 8.4, 95% CI 0.65–16.07, ηp 2 = 0.136, p = 0.034). The mean distance walked per session for ORE group was almost three times that of control for those with baseline FAC 0 (121.5 [SD 31.1]m vs 35.0 [SD 41.0]m, 95% CI 62.2–110.9, d = 2.54 p < 0.001) and FAC 1 (145.8 [SD 31.6]m vs 52.2 [SD 42.5]m, 95% CI 61.8–125.2, d = 2.71, p < 0.001). The difference was not observed for FAC 2 to 3 (162.9 [SD 29.2]m vs 134.2 [SD 87.5]m, 95% CI −22.2 to 79.7, d = 0.41, p = 0.252). Conclusion In a pragmatic setting, use of ORE for gait training enabled patients with lower ambulatory capacity to walk longer distances during therapy sessions. Patients who required continuous assistance during ambulation (FAC 1) had significantly better gains in FIM-motor compared to conventional therapy, suggesting possible benefit of ORE for this group. Trial Registration The trial was registered with clinicaltrials.gov (NCT05659121) on April 14, 2022.https://doi.org/10.1186/s12984-024-01536-1StrokeExoskeletonRoboticGaitRehabilitation |
| spellingShingle | Pui Kit Tam Ning Tang Nur Shafawati Binte Kamsani Thian Yong Yap Ita Coffey-Aladdin Shi Min Goh Jean Pei Pei Tan Yook Cing Lui Rui Ling Lee Ramaswamy Suresh Effie Chew Overground robotic exoskeleton vs conventional therapy in inpatient stroke rehabilitation: results from a pragmatic, multicentre implementation programme Journal of NeuroEngineering and Rehabilitation Stroke Exoskeleton Robotic Gait Rehabilitation |
| title | Overground robotic exoskeleton vs conventional therapy in inpatient stroke rehabilitation: results from a pragmatic, multicentre implementation programme |
| title_full | Overground robotic exoskeleton vs conventional therapy in inpatient stroke rehabilitation: results from a pragmatic, multicentre implementation programme |
| title_fullStr | Overground robotic exoskeleton vs conventional therapy in inpatient stroke rehabilitation: results from a pragmatic, multicentre implementation programme |
| title_full_unstemmed | Overground robotic exoskeleton vs conventional therapy in inpatient stroke rehabilitation: results from a pragmatic, multicentre implementation programme |
| title_short | Overground robotic exoskeleton vs conventional therapy in inpatient stroke rehabilitation: results from a pragmatic, multicentre implementation programme |
| title_sort | overground robotic exoskeleton vs conventional therapy in inpatient stroke rehabilitation results from a pragmatic multicentre implementation programme |
| topic | Stroke Exoskeleton Robotic Gait Rehabilitation |
| url | https://doi.org/10.1186/s12984-024-01536-1 |
| work_keys_str_mv | AT puikittam overgroundroboticexoskeletonvsconventionaltherapyininpatientstrokerehabilitationresultsfromapragmaticmulticentreimplementationprogramme AT ningtang overgroundroboticexoskeletonvsconventionaltherapyininpatientstrokerehabilitationresultsfromapragmaticmulticentreimplementationprogramme AT nurshafawatibintekamsani overgroundroboticexoskeletonvsconventionaltherapyininpatientstrokerehabilitationresultsfromapragmaticmulticentreimplementationprogramme AT thianyongyap overgroundroboticexoskeletonvsconventionaltherapyininpatientstrokerehabilitationresultsfromapragmaticmulticentreimplementationprogramme AT itacoffeyaladdin overgroundroboticexoskeletonvsconventionaltherapyininpatientstrokerehabilitationresultsfromapragmaticmulticentreimplementationprogramme AT shimingoh overgroundroboticexoskeletonvsconventionaltherapyininpatientstrokerehabilitationresultsfromapragmaticmulticentreimplementationprogramme AT jeanpeipeitan overgroundroboticexoskeletonvsconventionaltherapyininpatientstrokerehabilitationresultsfromapragmaticmulticentreimplementationprogramme AT yookcinglui overgroundroboticexoskeletonvsconventionaltherapyininpatientstrokerehabilitationresultsfromapragmaticmulticentreimplementationprogramme AT ruilinglee overgroundroboticexoskeletonvsconventionaltherapyininpatientstrokerehabilitationresultsfromapragmaticmulticentreimplementationprogramme AT ramaswamysuresh overgroundroboticexoskeletonvsconventionaltherapyininpatientstrokerehabilitationresultsfromapragmaticmulticentreimplementationprogramme AT effiechew overgroundroboticexoskeletonvsconventionaltherapyininpatientstrokerehabilitationresultsfromapragmaticmulticentreimplementationprogramme |