The assistive gait devices and their implementation in activities of daily living for patients with neuromuscular disease: A systematic review and meta-analysis

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BACKGROUND: To date, assistive gait devices (AGDs) for people with neuromuscular diseases (NMDs) have not been systematically evaluated. OBJECTIVE: This systematic review evaluated AGDs for people with NMDs.MethodsSuitable tools were used to assess the study quality and the certainty of evidence. If feasible, a descriptive and quantitative synthesis was conducted. RESULTS: Forty studies were included on: gait-assisting exoskeletons (GAEs), orthopaedic footwear (OF), knee and/or ankle-foot-orthoses (AFOs) and non-invasive neuroprostheses that provide functional electrical stimulation (FES). Pairwise meta-analysis could not be performed due to a lack of homogenous data. The within-group pre-post meta-analysis in GAE studies showed an improvement in 2-min walk test (2MWT) (m) (standardized mean difference [SMD] = 0.36, 95%-CI: 0.17 to 0.54), but not in 10-meter walk test (10MWT) (sec) (SMD = 0.33, 95%-CI: -0.10 to 0.76) and in functional independence measure (FIM) (SMD = -0.002, 95%-CI: -0.21 to 0.21). In AFO studies, there was no improvement in 10MWT(m) (SMD = -0.11, 95%-CI: -0.76 to 0.53). A single session with AFO or OF vs no-AFO or OF post-intervention meta-analysis did not reveal an improvement in walking speed (m/s) (SMD = 0.39, 95%-CI: -0.03 to 0.83). DISCUSSION: GAEs seem to help patients to walk longer. The meta-analyses showed no significant results to support the effect of AFOs or OF. Neuroprostheses and knee orthoses showed no evidence. CONCLUSION: No clear conclusions can be drawn on how AGDs affect NMDs. The positive AGD effects are based on very low certainty of evidence.

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