Effects of robot-assisted gait training within 1 week after stroke onset on degree of gait independence in individuals with hemiparesis: a propensity score-matched analysis in a single-center cohort study

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Effects of robot-assisted gait training within 1 week after stroke onset on degree of gait independence in individuals with hemiparesis: a propensity score-matched analysis in a single-center cohort study

• Daisuke Kato,
• Satoshi Hirano,
• Daisuke Imoto,
• Takuma Ii,
• Takuma Ishihara,
• Daisuke Matsuura,
• Hirofumi Maeda,
• Yoshitaka Wada &
• Yohei Otaka 

Journal of NeuroEngineering and Rehabilitation volume 22, Article number: 42 (2025) Cite this article

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Abstract

Background

Robot-assisted gait training (RAGT) is an effective method for treating gait disorders in individuals with stroke. However, no previous studies have demonstrated the effectiveness of RAGT in individuals with acute stroke. This study aimed to investigate the effects of RAGT initiation within 1 week after onset on degree of gait independence in individuals with hemiparetic stroke.

Methods

This retrospective cohort study used propensity-score matching. Individuals admitted to Fujita Health University Hospital after stroke onset and underwent RAGT between March 2017 and June 2023 were enrolled. Ninety-two individuals were eligible and grouped into the acute (≤ 7 days after the onset) and subacute groups (8–90 days after onset). RAGT was conducted using Welwalk, primarily comprising a knee–ankle–foot orthosis type robot worn on one paralyzed lower extremity, with training sessions lasting approximately 40 min/day, occurring 3–7 days/week. The primary outcome was the gait under supervision within 90 days of onset, which was compared between groups using the log-rank test.

Results

After propensity-score matching, 36 individuals were included in the analysis, including 18 each in the acute and subacute groups; the participant demographics were not significantly different between the groups. RAGT was initiated at a median of 6 and 25 days after onset in the acute and subacute groups, respectively. The Kaplan–Meier curves after the log-rank test showed a significantly higher percentage and shorter median days to achieve gait under supervision in the acute group than in the subacute group. The cumulative incidence of gait under supervision events at 90 days after onset was 82.2% and 55.6% in the acute and the subacute groups, respectively. Half of the individuals achieved gait under supervision within 49 days and 75 days in the acute and subacute groups, respectively (p = 0.038). No significant differences were observed in the dose of rehabilitation program and gait training per day from onset to achieving gait under supervision.

Conclusion

Initiation of RAGT within 1 week after stroke onset in individuals with hemiparesis may reduce the number of days required to achieve gait under supervision and increase the percentage of gait under supervision.

Background

Stroke is one of the leading causes of physical disability worldwide, resulting in gait disorders [1, 2]. The percentage of individuals with stroke who have achieved gait independence is estimated to be 41–85% [3]. Gait disorders limit the activities of daily living and social participation [4]. Therefore, improving gait is an important goal in stroke rehabilitation.

Robot–assisted gait training (RAGT) is an effective method for treating gait disorders in individuals with stroke. RAGT can provide intensive, repetitive, and task-oriented training for individuals with hemiplegic stroke who have difficulty walking independently by partially or completely supporting their weight and movement using a robotic control mechanism [5]. A systematic review and meta-analysis reported that RAGT combined with conventional physical therapy for individuals with stroke is effective in improving gait independence within 3 months of stroke onset and in those who are unable to walk [6]. Therefore, RAGT for individuals with stroke is widely recommended in treatment guidelines [7, 8].

A retrospective study reported that early initiation of RAGT improved the degree of gait independence in individuals with subacute strokes, suggesting that early initiation of RAGT may improve the degree of gait independence [9]. It is important to start post-stroke rehabilitation early after stroke onset to achieve favorable clinical outcomes [10]. However, it is not clear how early RAGT should be initiated to improve the degree of gait independence in individuals with stroke who are unable to walk within 3 months of onset. The aforementioned systematic review and meta-analysis included RCTs of individuals with stroke 2–8 weeks after stroke onset [6]. Other systematic reviews investigating the efficacy of RAGT have consistently shown its effectiveness in improving gait ability among individuals with stroke within 3 months after onset but have not included RCTs conducted within the first week after stroke [11,12,13]. Therefore, the effect of initiating RAGT in the acute phase within 1 week of stroke onset is unclear. We hypothesized that the initiation of RAGT within 1 week may improve the degree of gait independence earlier than initiation of RAGT in the subacute phase. To the best of our knowledge, no previous studies have demonstrated the effectiveness of RAGT in individuals with acute stroke. This study aimed to investigate the effect of RAGT initiation within 1 week after onset on the degree of gait independence in individuals with hemiparetic stroke.