Robotic-assisted gait training for spinal cord injury neuropathic pain: A systematic review

Abstract

CONTEXT: Neuropathic pain (NP), can be a debilitating consequence of spinal cord injury. Robotic-assisted gait training (RAGT) is an effective rehabilitation tool, but emerging evidence suggests it may prove an effective treatment for NP post-SCI. OBJECTIVE: This systematic review aims to synthesize the available evidence examining RAGT for pain reduction post-SCI, focusing on NP. METHODS: Six databases were searched from inception to February 18th 2025, using search strings addressing: SCI and RAGT. No date or study type restrictions applied. Studies with SCI populations, delivering RAGT and measuring pain outcomes were included. Meta-analyses were conducted for pain intensity, pain interference (PI) and HRQoL outcomes. Certainty of evidence (COE) was assessed using GRADE criteria. RESULTS: Thirty two studies (n = 567) (6 RCTs) met eligibility criteria. No RCT mandated pain as an inclusion criterion. Meta-analysis of 6 RCTs (n = 174) identified no effect for RAGT over other interventions for outcomes of overall pain intensity (SMD = 0.03 [-0.40, 0.46]; P = 0.90), non-specified pain-type intensity (SMD = 0.08 [-0.39, 0.55]; P = 0.74) and in one RCT reporting NP intensity (SMD = -0.46 [-1.61, 0.70]; P = 0.44). Meta-analysis identified no difference between RAGT and comparators for outcomes of HRQoL (3 RCTs (n = 69): SMD = 0.15 [-0.33,0.62]; P = 0.54) and PI (2 RCTs (n = 53): SMD = -0.1 [-0.64,0.44]; P = 0.71). Very-low COE for pain intensity & PI and low COE for HRQoL were assigned. CONCLUSIONS: Very limited studies and inconclusive evidence supports RAGT for the reduction of NP post-SCI. Future RCTs of RAGT that recruit patients with moderate-to-severe NP at baseline are required.