Robotic Rehabilitation for Gait Imbalance in Patients with Multiple Sclerosis (MS): a Systematic Review and Meta-Analysis.

Objective: To estimate the pooled effect of robotic rehabilitation on gait in subjects with multiple sclerosis (MS).

Methods: We conducted a systematic search in PubMed, Scopus, EMBASE, IEEE and Web of Science databases on October 1 st 2022, without any time or language limitation. Also, we investigated the grey literature, including conference abstract and references of references, to identify potentially relevant articles. The primary outcomes were the six-minute walking test (6MWT) and Timed Up and Go (TUG). The risk of bias in the included studies was evaluated using the Cochrane's risk of bias tool for non-randomized studies (ROBINS-I) and the Cochrane risk-of-bias tool for randomized trials (RoB2). Meta-analyses were performed using a fixed-effects model as the heterogeneity between study results (I2) was less than 50%. The standardized mean difference (SMD) was calculated as the effect size for study outcomes.

Results: Our systematic search retrieved 6878 studies and, after deleting duplicate results, 5019 articles remained. Two researchers screened the titles and abstracts, with 4942 studies remaining for further screening. After full-text assessment, 12 studies were included for meta-analysis, most of which were conducted in the USA and Italy and were published between 2007 and 2022. The mean age of participants in the selected studies ranged between 46-55 years and the mean expanded disability status scale (EDSS) between 5 and 6.5. The SMD of 6MWT (AFTER-BEFORE) was 0.22 (95% CI -0.01-0.45) (I 2 =0%, P=0.90). The SMD of TUG (AFTER-BEFORE) was -0.29 (95% CI -0.56, -0.02) (I 2 =0%, P=0.70).

Conclusion: This systematic review and meta-analysis concluded that robotic rehabilitation was effective for gait rehabilitation in patients with MS.