Effectiveness of lower limb robotic rehabilitation on peak of oxygen uptake among patients with stroke: a systematic review and meta-analysis

Objectives To evaluate the effectiveness of lower limb robotic rehabilitation (LLRR) on cardiovascular health among individuals with stroke undergoing rehabilitation. Design Systematic reviews and meta-analysis. Data sources PubMed, Web of Science, Science Direct, Embase, China National Knowledge Infrastructure, Wangfang and VIP databases were searched from inception to 9 October 2023. Eligibility criteria Randomised controlled trials (RCTs) involving LLRR among individuals with stroke were included. We considered the potential impact of LLRR on the resting heart rate (HRrest), peak of oxygen uptake (VO(2)peak), peak of systolic blood pressure (SBPpeak) and peak of diastolic blood pressure (DBPpeak). Only studies published in Chinese or English were included. Data extraction and synthesis Two reviewers independently extracted data and assessed the risk of bias. Results were reported as Hedges' g with 95% CIs. Meta-analyses were performed using a random effects model in STATA v17.0. The study was reported in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Results Five RCTs with 179 patients were included in the meta-analysis. According to the Guideline Development Tool results, half of the evidence grades were moderate. The results of the meta-analysis showed that there were significant differences among robotic rehabilitation group than the control group in VO(2)peak (standard mean difference (SMD): 0.71, 95% CI: (0.28, 1.13), p<0.001, I-2=45.61%), but insignificant difference found in HRrest (SMD: 0.30, 95% CI: (-0.12, 0.73), p=0.16, I-2=34.25%), SBPpeak (SMD: 0.04, 95% CI: (-0.44, 0.52), p=0.86, I-2=28.75%) and DBPpeak (SMD: 0.46, 95% CI: (-3.82, 4.73), p=0.83, I-2=0.00%). No significant heterogeneity was found among articles. The risk of bias assessment revealed that two studies showed low bias in most domains. Conclusion Individuals undergoing stroke rehabilitation may benefit from LLRR with improved VO(2)peak but insignificantly impacted HRrest, SBPpeak and DBPpeak. PROSPERO registration number CRD42022382259.