Cochrane Database Syst Rev

Post-stroke electromechanical and robotic gait‐training: Is it better than usual rehabilitation?

May 29, 2025

Electromechanical‐assisted gait training device use combined with physical therapy probably results in increased odds of independent walking vs. gait training alone post-stroke, according to moderate‐certainty evidence in this systematic review. However, authors recommend interpreting results with caution, as some trials included patients who were independently walking at study start, and there was variation regarding the different devices used, as well as device treatment frequency and duration.

• Study details: This review included 101 randomized controlled studies (N=4224 adults, post-stroke) that assessed walking velocity and capacity, treatment acceptability, and death from all causes during the intervention. Key outcomes included the ability to walk independently as measured by a Functional Ambulation Category score of 4 or 5 over a 15‐meter surface, irrespective of aids (e.g., cane).
• Results: Electromechanical‐assisted gait training, combined with physical therapy, probably increases the odds of walking independence (moderate‐certainty evidence); probably doesn’t increase mean walking-velocity (moderate‐certainty evidence); and doesn’t increase mean walking-capacity (high‐certainty evidence). There was no effect on the risk of study drop-out or risk of death from all causes (high‐certainty evidence).
• Clinical impact: Authors concluded that nine patients would need to be treated to prevent one patient with walking dependency. Future research is warranted to explore the optimal frequency and duration of device use, initiation timing post-stroke, and duration of benefit.

Source:

Mehrholz J, et al. (2025, May 14). Cochrane Database Syst Rev. Electromechanical-assisted training for walking after stroke. https://pubmed.ncbi.nlm.nih.gov/40365867