Does robot-assisted gait training represent a true advancement in post-stroke walking rehabilitation?

Abstract

Introduction: Robot-assisted gait training (RAGT) has gained prominence in stroke rehabilitation, promoted as a technologically advanced intervention to improve walking outcomes. However, evidence from clinical trials and systematic reviews paints a more equivocal picture. Despite its widespread adoption, questions persist regarding its true clinical utility and whether it offers meaningful benefits beyond conventional physiotherapy.

Areas covered: This perspective evaluates the evidence base for RAGT by critically reviewing recent systematic reviews and randomized controlled trials, with particular attention to study designs, comparator interventions, and reported outcomes. It highlights the overreliance on surrogate outcomes and underlines the need to focus on meaningful functional endpoints like walking independence and community mobility. Studies that directly compare RAGT with task-specific overground gait training (TOGT) are emphasized, as these provide the most relevant insights into RAGT's additive value.

Expert opinion: Without evidence of clear additive value, the continued emphasis on RAGT may reflect technological enthusiasm more than therapeutic necessity. The field must reconsider its priorities, redirecting research efforts toward optimizing scalable, high-intensity TOGT that aligns more closely with real-world functional recovery. Future research should prioritize direct comparisons between RAGT and optimized TOGT, with a stronger focus on outcomes that matter to patients.