Effect of Robot-Assisted Gait Training on Multiple Sclerosis: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

BACKGROUND: In recent meta-analyses, robot-assisted gait training for patients with multiple sclerosis (MS) have yielded limited clinical benefits compared with conventional overground gait training. OBJECTIVE: To investigate the effect of robot-assisted gait training for patients with MS on clinical outcomes through a systematic review and meta-analysis. METHODS: We searched for relevant studies in the PubMed, EMBASE, Cochrane Library, and Physiotherapy Evidence Database databases from their inception to April 7, 2022. We selected studies that (1) included participants with MS, (2) used robot-assisted gait training as the intervention, (3) included conventional overground gait training or another gait training protocol as control treatment, and (4) reported clinical outcomes. Continuous variables are expressed as standardized mean differences with 95% confidence intervals. Statistical analyses were performed using RevMan 5.4 software. RESULTS: We included 16 studies enrolling 536 participants. Significant improvement was observed in the intervention group, with low heterogeneity at the end of the intervention with regard to walking velocity (standardized mean difference [SMD]: 0.38, 95% confidence interval [CI]: [0.15, 0.60]), walking endurance (SMD: 0.26, 95% CI [0.04, 0.48]), mobility (SMD: -0.37, 95% CI [-0.60, -0.14]), balance (SMD: 0.26, 95% CI [0.04, 0.48]), and fatigue (SMD: -0.27, 95% CI [-0.49, -0.04]). The results of subgroup analyses revealed improvements in these outcomes for the intervention group using grounded exoskeletons. No significant differences were noted in all the outcomes between the groups at follow-up. CONCLUSIONS: Robot-assisted gait training with grounded exoskeletons exerts a positive short-term effect and is an adequate treatment option for patients with MS.

Effectiveness of neuromuscular electrical stimulation in improving mobility in children with cerebral palsy: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: To investigate whether neuromuscular electrical stimulation improves mobility in children with spastic cerebral palsy. METHODS: PubMed, Cochrane, EMBASE, and Scopus were searched for randomized controlled trials studying the effects of NMES on the lower limbs in children with spastic CP. Randomized controlled trials comparing the effect of neuromuscular electrical stimulation with that of placebo or conventional therapy on mobility in children with cerebral palsy were eligible for inclusion. Two reviewers independently screened studies, extracted data, and examined the risk of bias and quality of evidence by using the revised Cochrane Risk-of-Bias Tool for Randomized Trials (RoB 2.0) and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method. The final search was conducted on May 23, 2022. RESULTS: A total of 14 randomized controlled trials (2 crossover studies and 12 parallel studies including 421 patients) were included in this meta-analysis. Compared with the control group (conventional physical therapy), the treatment group exhibited greater improvement in walking speed (standardized mean difference = 0.29; 95% confidence interval = 0.02-0.57) and the standing, walking, running, and jumping dimension of the Gross Motor Function Measure (standardized mean difference = 1.24; 95% confidence interval = 0.64-1.83). CONCLUSION: Neuromuscular electrical stimulation improved mobility in children with spastic cerebral palsy, particularly in standing, running, and jumping function, and it is safe for children with spastic cerebral palsy.

The effectiveness of functional electrical stimulation of the legs in patients with heart failure: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: To investigate the effectiveness of functional electrical stimulation of the legs in patients with heart failure. METHODS: Data were obtained from PubMed, Cochrane Library, and Embase databases until August 12, 2021. We included randomized controlled trials that evaluated the effects of functional electrical stimulation applied to the legs of patients with heart failure, namely changes in cardiopulmonary function, muscle strength, and quality of life. RESULTS: In total, 14 randomized controlled trials (consisting of 518 patients) were included in our article. Pooled estimates demonstrated that functional electrical stimulation significantly improved peak oxygen consumption (peak VO2; standardized mean difference = 0.33, 95% confidence interval = 0.07-0.59, eight randomized controlled trials, n = 321), 6-min walking distance (mean difference = 48.03 m, 95% confidence interval = 28.50-67.57 m, 10 randomized controlled trials, n = 380), and Minnesota Living with Heart Failure Questionnaire quality of life score (mean difference = - 8.23, 95% confidence interval = - 12.64 to - 3.83, nine randomized controlled trials, n = 383). Muscle strength of lower extremities was not significantly improved in the functional electrical stimulation group compared with that in the control group (standardized mean difference = 0.26, 95% confidence interval = - 0.18 to 0.71, five randomized controlled trials, n = 218). Furthermore, the subgroup analysis revealed that functional electrical stimulation significantly improved peak VO2, 6-min walking distance, and Minnesota Living with Heart Failure Questionnaire quality of life score in the heart failure with reduced ejection fraction and heart failure with preserved ejection fraction subgroups. CONCLUSION: Functional electrical stimulation can effectively improve the cardiopulmonary function and quality of life in patients with heart failure. However, functional electrical stimulation did not significantly improve muscle strength in the legs.