Méta-analyse : utilisation de la robotique pour la rééducation à la marche après un accident vasculaire cérébral

Meta-analysis: use of robot for gait training after a stroke Background: Robot devices are often used in rehabilitation and might be efficient to improve walking capacities after stroke. Objective: To investigate the effects of robotic-assisted-gait-training (RAGT) for recovering of the gait after a stroke. Methods: We included all randomized controlled trials in adults diagnosed with stroke, evaluating robotic-assisted gait training +/- combined with electromechanical devices versus normal care. We searched in MEDLINE, EMBASE, CENTRAL, CINAHL, OPENGREY, OPENSIGLE, PEDRO, WEB OF SCIENCE, CLINICAL TRIALS; conference proceedings and bibliography of other meta-analysis. Two review authors researched separately the trials and extracted data from published reports from the oldest we could find until October 2017. We collected the mean values of walking speed, walking endurance, the Berg Balance Scale (BBS), the Functional Ambulation Classification (FAC) and the Timed Up and Go (TUG) at the beginning of studies and after the rehabilitation program. We also noted: the method of randomization, the blinding of outcome assessors, the drop-outs, the intention to treat (or not), the country, the number of participants, the disease duration, the mean age, the features of interventions, the date of outcomes assessment. Results: We included 42 studies involving 1243 participants. We proposed an analysis by subgroup of intervention and we found that combination of physiotherapy, body-weight-support-training and robot-assisted-gait-training was better than physiotherapy alone for gait speed outcome (+ 0,09 m/s (95% CI 0,02 to 0,15); P= 0,009) and for Funtional Ambulation Classification outcome (+ 0,55 (95% CI 0,10 to 1,00); P=0,016). What is more, we proved by metaregression that these results were underestimated by the attrition bias of studies. Conclusions: Stroke patients who receive combination of physiotherapy, body-weight-support-training and robot-a ssisted-gaittraining are more likely to progress their gait speed and their walking autonomy (FAC).